Background: The targets of Sustainable Development Goals cannot be achieved without reducing mortality of inborn as well as outborn neonates. Objective: The objective was to predict the mortality of neonates by applying Modified Sick Neonatal Score (MSNS). Material and Methods: Parameters of MSNS scoring system were applied to 450 neonates at the time of admission and followed up prospectively till discharge or death. The score and individual parameters were correlated with outcome. A receiver operating curve was plotted to determine the cutoff value for score to predict the mortality. Results: The common clinical diagnoses were respiratory distress (38%), sepsis (26%), and jaundice (14.44%). Sixty-two percent neonates were born at term and 38% were preterm while 55.56% neonates were low birth weight and 44.4% were weighted more than 2500 gms. Neonates who died were older at the time of admission, and duration of hospital stay was shorter compared to alive neonates (P < 0.001) with a mortality rate of 23.11%. The total MSNS for neonates who died was statistically significantly low, (mean ± standard deviation) 7.93 ± 2.70, compared to alive neonates, 12.02 ± 1.84 (P < 0.0001). With optimum cutoff score of ≤10, the sensitivity was 79.80% and the specificity was 82.37% while the positive predictive value and negative predictive value was 57.64% and 93.14% respectively with the area under curve was 0.89 (odds ratio-18.46, 95% confidence interval 10.3-33.64, P < 0.0001). Conclusion: The MSNS of ≤10 has a better sensitivity and specificity in predicting neonatal mortality and is easy to use with minimal resources to both preterm and term neonates.
{"title":"Role of modified sick neonatal score in predicting the neonatal mortality at limited-resource setting of central India","authors":"R. Meshram, Roshan Nimsarkar, Ayushi Nautiyal","doi":"10.4103/jcn.jcn_83_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_83_22","url":null,"abstract":"Background: The targets of Sustainable Development Goals cannot be achieved without reducing mortality of inborn as well as outborn neonates. Objective: The objective was to predict the mortality of neonates by applying Modified Sick Neonatal Score (MSNS). Material and Methods: Parameters of MSNS scoring system were applied to 450 neonates at the time of admission and followed up prospectively till discharge or death. The score and individual parameters were correlated with outcome. A receiver operating curve was plotted to determine the cutoff value for score to predict the mortality. Results: The common clinical diagnoses were respiratory distress (38%), sepsis (26%), and jaundice (14.44%). Sixty-two percent neonates were born at term and 38% were preterm while 55.56% neonates were low birth weight and 44.4% were weighted more than 2500 gms. Neonates who died were older at the time of admission, and duration of hospital stay was shorter compared to alive neonates (P < 0.001) with a mortality rate of 23.11%. The total MSNS for neonates who died was statistically significantly low, (mean ± standard deviation) 7.93 ± 2.70, compared to alive neonates, 12.02 ± 1.84 (P < 0.0001). With optimum cutoff score of ≤10, the sensitivity was 79.80% and the specificity was 82.37% while the positive predictive value and negative predictive value was 57.64% and 93.14% respectively with the area under curve was 0.89 (odds ratio-18.46, 95% confidence interval 10.3-33.64, P < 0.0001). Conclusion: The MSNS of ≤10 has a better sensitivity and specificity in predicting neonatal mortality and is easy to use with minimal resources to both preterm and term neonates.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"12 1","pages":"1 - 6"},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41654871","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}
In neonatal intensive units, invasive fungal infection remains a significant cause of morbidity and mortality, although an unusual cause of early-onset neonatal sepsis. In this report, we present a case of Candida parapsilosis infection presenting as early-onset bacterial sepsis. The patient was a 6-day-old male preterm neonate (estimated gestational age of 32 weeks) admitted to our neonatal unit on account of fever, refusal to feed, and vomiting which started during the first 24 h of life. Initially, he was managed for early-onset neonatal sepsis. However, his clinical state deteriorated within the 1st week of admission and his blood culture yielded C. parapsilosis. His clinical condition subsequently improved significantly following the administration of intravenous amphotericin. He spent a total of 25 days on admission before discharge. Our report reiterates the need to raise the index of suspicion for invasive fungal infection in cases of early-onset neonatal sepsis with poor response to appropriate and potent antibiotics.
{"title":"Invasive fungal infection presenting as early-onset neonatal sepsis: A case report from Northern Nigeria","authors":"U. Sanni, Taslim O. Lawal, A. Na'uzo, L. Audu","doi":"10.4103/jcn.jcn_98_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_98_22","url":null,"abstract":"In neonatal intensive units, invasive fungal infection remains a significant cause of morbidity and mortality, although an unusual cause of early-onset neonatal sepsis. In this report, we present a case of Candida parapsilosis infection presenting as early-onset bacterial sepsis. The patient was a 6-day-old male preterm neonate (estimated gestational age of 32 weeks) admitted to our neonatal unit on account of fever, refusal to feed, and vomiting which started during the first 24 h of life. Initially, he was managed for early-onset neonatal sepsis. However, his clinical state deteriorated within the 1st week of admission and his blood culture yielded C. parapsilosis. His clinical condition subsequently improved significantly following the administration of intravenous amphotericin. He spent a total of 25 days on admission before discharge. Our report reiterates the need to raise the index of suspicion for invasive fungal infection in cases of early-onset neonatal sepsis with poor response to appropriate and potent antibiotics.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"12 1","pages":"38 - 41"},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41716911","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: Postnatal growth depends on multiple factors such as gestational age, associated morbidities, and the nutrition and varies from one newborn to another. Preterm babies in neonatal intensive care unit are very much susceptible to growth faltering even after adequate nutrition and supplements. The positioning of preterm infants in neonatal intensive care has an impact on their survival and neurological outcome. Prone positioning is known to improve oxygenation, minute ventilation, and functional residual capacity. Quiet undisturbed sleep in preterms has helped them to conserve energy for growth. Objective: To determine the effect of prone versus supine position on weight gain in infants less than 32 weeks of gestational age. Design: Prospective observational study. Participants: Twenty-two neonates were recruited. Results: On day 1, in the prone position, 63.6% gained weight vs. 59.1% in the supine position (P = 0.425). On day 2, in prone, 72.7% has gained vs. 63.6% in supine (P = 0.359). On day 3, in prone, 68.2% gained weight vs. 63.6% in supine position (P = 0.426). Conclusion: Nursing a baby in a prone position has demonstrated weight gain over nursing in a supine position though not statistically significant.
{"title":"Impact of a short period of prone versus supine nursing in preterm neonates less than 32 weeks on weight gain: A prospective observational study","authors":"H. Venkatesh, P. Mohanty","doi":"10.4103/jcn.jcn_89_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_89_22","url":null,"abstract":"Background: Postnatal growth depends on multiple factors such as gestational age, associated morbidities, and the nutrition and varies from one newborn to another. Preterm babies in neonatal intensive care unit are very much susceptible to growth faltering even after adequate nutrition and supplements. The positioning of preterm infants in neonatal intensive care has an impact on their survival and neurological outcome. Prone positioning is known to improve oxygenation, minute ventilation, and functional residual capacity. Quiet undisturbed sleep in preterms has helped them to conserve energy for growth. Objective: To determine the effect of prone versus supine position on weight gain in infants less than 32 weeks of gestational age. Design: Prospective observational study. Participants: Twenty-two neonates were recruited. Results: On day 1, in the prone position, 63.6% gained weight vs. 59.1% in the supine position (P = 0.425). On day 2, in prone, 72.7% has gained vs. 63.6% in supine (P = 0.359). On day 3, in prone, 68.2% gained weight vs. 63.6% in supine position (P = 0.426). Conclusion: Nursing a baby in a prone position has demonstrated weight gain over nursing in a supine position though not statistically significant.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"12 1","pages":"13 - 15"},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46280614","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}
L. Raffa, Omar Akeely, Saleh Alariefy, Faisal A Alharbi, Moussa A Alkhateeb, M. Khan
Background: In developing countries, data on the applicability of existing models to predict retinopathy of prematurity (ROP) are scarce. The study aimed to validate the Alexandria ROP (Alex-ROP) and high-grade Alex-ROP (Hg Alex-ROP) models retrospectively to identify treatable ROP in a cohort of preterm infants in Saudi Arabia. Materials and Methods: We reviewed and included the records of 281 infants born prematurely in 2015–2021. We recorded the infants' demographics, gestational age at birth (GA), birth weight (BW), and serial weight measurements (day 7, 14, 21, and 28). We determined whether the included met the Alex-ROP and Hg Alex-ROP detection criteria for treatable or any-stage ROP and calculated the specificity, sensitivity, negative and positive predictive values, and accuracy. Results: The median BW and GA was 1095 g (range: 426–1920 g) and 29 weeks (range: 23–36 weeks), respectively. ROP developed in 112 infants, of which 30 cases were treatable. The Alex-ROP sensitivity for correctly predicting any-stage ROP and treatable ROP was 77.7% and 80.0%, respectively, and its specificity for predicting any-stage ROP and treatable ROP was 49.7% and 41%, respectively. The Hg Alex-ROP had 36.6% and 50.0% sensitivity for detecting any-stage ROP and treatable ROP, respectively, and its specificity for detecting any-stage ROP and treatable ROP was 83.4% and 78.5%, respectively. Conclusion: Previously published accuracy parameters were not reproducible in this cohort and a significant number of children requiring treatment would have been missed if the Alex-ROP or Hg Alex-ROP were applied.
背景：在发展中国家，关于现有模型预测早产儿视网膜病变（ROP）的适用性的数据很少。该研究旨在回顾性验证Alexandria ROP（Alex ROP）和高级Alex ROP（Hg Alex ROP）模型，以确定沙特阿拉伯早产儿队列中可治疗的ROP。材料和方法：我们回顾并纳入了2015-2021年281名早产婴儿的记录。我们记录了婴儿的人口统计数据、出生时的胎龄（GA）、出生体重（BW）和一系列体重测量值（第7、14、21和28天）。我们确定入选者是否符合可治疗或任何阶段ROP的Alex ROP和Hg Alex ROP检测标准，并计算特异性、敏感性、阴性和阳性预测值以及准确性。结果：中位BW和GA分别为1095 g（范围：426–1920 g）和29周（范围：23–36周）。112名婴儿发生ROP，其中30例可治疗。Alex ROP对正确预测任何阶段ROP和可治疗ROP的敏感性分别为77.7%和80.0%，对预测任何阶段ROP和可治愈ROP的特异性分别为49.7%和41%。Hg Alex ROP检测任何阶段ROP和可治疗ROP的敏感性分别为36.6%和50.0%，检测任何阶段ROP和可治愈ROP的特异性分别为83.4%和78.5%。结论：先前公布的准确性参数在该队列中不可重复，如果应用Alex ROP或Hg Alex ROP，将错过大量需要治疗的儿童。
{"title":"Retrospective validation of the Alexandria retinopathy of prematurity model in preterm infants in Saudi Arabia","authors":"L. Raffa, Omar Akeely, Saleh Alariefy, Faisal A Alharbi, Moussa A Alkhateeb, M. Khan","doi":"10.4103/jcn.jcn_87_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_87_22","url":null,"abstract":"Background: In developing countries, data on the applicability of existing models to predict retinopathy of prematurity (ROP) are scarce. The study aimed to validate the Alexandria ROP (Alex-ROP) and high-grade Alex-ROP (Hg Alex-ROP) models retrospectively to identify treatable ROP in a cohort of preterm infants in Saudi Arabia. Materials and Methods: We reviewed and included the records of 281 infants born prematurely in 2015–2021. We recorded the infants' demographics, gestational age at birth (GA), birth weight (BW), and serial weight measurements (day 7, 14, 21, and 28). We determined whether the included met the Alex-ROP and Hg Alex-ROP detection criteria for treatable or any-stage ROP and calculated the specificity, sensitivity, negative and positive predictive values, and accuracy. Results: The median BW and GA was 1095 g (range: 426–1920 g) and 29 weeks (range: 23–36 weeks), respectively. ROP developed in 112 infants, of which 30 cases were treatable. The Alex-ROP sensitivity for correctly predicting any-stage ROP and treatable ROP was 77.7% and 80.0%, respectively, and its specificity for predicting any-stage ROP and treatable ROP was 49.7% and 41%, respectively. The Hg Alex-ROP had 36.6% and 50.0% sensitivity for detecting any-stage ROP and treatable ROP, respectively, and its specificity for detecting any-stage ROP and treatable ROP was 83.4% and 78.5%, respectively. Conclusion: Previously published accuracy parameters were not reproducible in this cohort and a significant number of children requiring treatment would have been missed if the Alex-ROP or Hg Alex-ROP were applied.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"12 1","pages":"7 - 12"},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44469756","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}
A. Naeem, Sajjad Rahman, M. Abdulghani, Yahya Almalki
Umbilical cord hematoma (UCH) is the extravasation of blood in the umbilical cord. The condition is rare and asymptomatic but very important to recognize because it can potentially compromise fetal blood flow. Hence, UCH increases the chances of fetal mortality and morbidity. We are presenting the case report of a large but asymptomatic UCH in a newborn baby with Down syndrome. To the best of our knowledge, the association between Down syndrome and UCH has not been reported in medical literature till the time of writing of this manuscript.
{"title":"Down syndrome with umbilical cord hematoma: Case report and review of literature","authors":"A. Naeem, Sajjad Rahman, M. Abdulghani, Yahya Almalki","doi":"10.4103/jcn.jcn_103_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_103_22","url":null,"abstract":"Umbilical cord hematoma (UCH) is the extravasation of blood in the umbilical cord. The condition is rare and asymptomatic but very important to recognize because it can potentially compromise fetal blood flow. Hence, UCH increases the chances of fetal mortality and morbidity. We are presenting the case report of a large but asymptomatic UCH in a newborn baby with Down syndrome. To the best of our knowledge, the association between Down syndrome and UCH has not been reported in medical literature till the time of writing of this manuscript.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"12 1","pages":"42 - 46"},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45421234","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}
A. Mallick, M. Bhandari, Bijit Basumatary, Shivani Gupta, K. Arora, A. Sahani
Pressure Ulcers (PU) are highly prevalent iatrogenic occurrences among hospitalized adults and neonatal patients. These decubitus ulcers are progressive in nature and are mostly seen in patients that are immobile for prolonged periods, either by virtue of being bedridden or chair bound. The continual pressure on the skin surfaces disrupts blood supply from the subcutaneous regions and leads to the development of PUs. Several treatment and prevention protocols have been defined for adult patients. However, there is a dearth of literature available for critically ill pediatrics or neonates and often adult practices are used to treat pressure injuries in them. There is a significant physiological and anatomical difference between the skin of newborns and adults or even older children. The dermal layer of a preterm neonate is <60% of the thickness of an adult and has a much higher susceptibility for developing pressure ulcers. The immune system of premature infants lacks an efficient antigenic specificity, diversity or immunologic memory, making them prone to lethal infections. The study was performed using search engines like PubMed, EMBASE and Google Scholar, with the focus of the search strategy being the breadth rather than the details of the study. Selected keywords were used alone or in combination with each other to retrieve relevant articles. This review focuses on the risk of developing PUs in neonates, explains the currently available solutions of PU prevention in adults, emphasizes the need for neonatal specific solutions and presents novel ideas for developing antisore bed for neonates.
{"title":"Risk factors for developing pressure ulcers in neonates and novel ideas for developing neonatal antipressure ulcers solutions","authors":"A. Mallick, M. Bhandari, Bijit Basumatary, Shivani Gupta, K. Arora, A. Sahani","doi":"10.4103/jcn.jcn_84_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_84_22","url":null,"abstract":"Pressure Ulcers (PU) are highly prevalent iatrogenic occurrences among hospitalized adults and neonatal patients. These decubitus ulcers are progressive in nature and are mostly seen in patients that are immobile for prolonged periods, either by virtue of being bedridden or chair bound. The continual pressure on the skin surfaces disrupts blood supply from the subcutaneous regions and leads to the development of PUs. Several treatment and prevention protocols have been defined for adult patients. However, there is a dearth of literature available for critically ill pediatrics or neonates and often adult practices are used to treat pressure injuries in them. There is a significant physiological and anatomical difference between the skin of newborns and adults or even older children. The dermal layer of a preterm neonate is <60% of the thickness of an adult and has a much higher susceptibility for developing pressure ulcers. The immune system of premature infants lacks an efficient antigenic specificity, diversity or immunologic memory, making them prone to lethal infections. The study was performed using search engines like PubMed, EMBASE and Google Scholar, with the focus of the search strategy being the breadth rather than the details of the study. Selected keywords were used alone or in combination with each other to retrieve relevant articles. This review focuses on the risk of developing PUs in neonates, explains the currently available solutions of PU prevention in adults, emphasizes the need for neonatal specific solutions and presents novel ideas for developing antisore bed for neonates.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"12 1","pages":"27 - 33"},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42402601","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}
Che Salim, A. Zaman, Hana Azhari, S. Makpol, S. Ishak, Z. Latiff, Dayang Anita Abdul Aziz
Objective: This was a new prospective study to determine the association between phytoestrogen levels in the cord blood and urine with normal and abnormal external genitalia in male newborns. Materials and Methods: One hundred and fifty-one term male newborns were enrolled. Cord blood and urine and medical photos of their external genitalia were obtained. Prematurity and multiple congenital anomalies or syndromic characteristics were excluded. Serum and urine levels of phytoestrogens (daidzein and genistein) were calculated using liquid chromatography/mass spectrometry. The normality of the appearance of the external genitalia of the males was determined by a consensus review by experts. Results: A total of 146 cord blood and 96 newborn urine samples were obtained; only two newborns had abnormal external genitalia. In the 144 babies with normal external genitalia, mean levels were determined to be as follows; serum daidzein 10.82 ng/ml, serum genistein 42.17 ng/ml, urine daidzein 69.91 ng/ml, and urine genistein 126.09 ng/ml. In the two babies with abnormal external genitalia, mean levels of each of the measured phytoestrogen were lower; however, there was no statistical significance between the two groups (P > 0.05). Conclusions: We successfully determined and developed a novel database on the levels of measurable phytoestrogens in serum and urine from male newborns with normal external genitalia. In the normal group, a higher concentration of serum and urinary phytoestrogens was correlated with the extension of the scrotal pigmentation above and proximal to the base of the penis. These data are useful to better understand the role of phytoestrogens in the development of male genitalia and for future research on newborns with abnormal external genitalia.
{"title":"Novel cord blood and urinary phytoestrogens levels in male neonates with normal external genitalia","authors":"Che Salim, A. Zaman, Hana Azhari, S. Makpol, S. Ishak, Z. Latiff, Dayang Anita Abdul Aziz","doi":"10.4103/jcn.jcn_95_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_95_22","url":null,"abstract":"Objective: This was a new prospective study to determine the association between phytoestrogen levels in the cord blood and urine with normal and abnormal external genitalia in male newborns. Materials and Methods: One hundred and fifty-one term male newborns were enrolled. Cord blood and urine and medical photos of their external genitalia were obtained. Prematurity and multiple congenital anomalies or syndromic characteristics were excluded. Serum and urine levels of phytoestrogens (daidzein and genistein) were calculated using liquid chromatography/mass spectrometry. The normality of the appearance of the external genitalia of the males was determined by a consensus review by experts. Results: A total of 146 cord blood and 96 newborn urine samples were obtained; only two newborns had abnormal external genitalia. In the 144 babies with normal external genitalia, mean levels were determined to be as follows; serum daidzein 10.82 ng/ml, serum genistein 42.17 ng/ml, urine daidzein 69.91 ng/ml, and urine genistein 126.09 ng/ml. In the two babies with abnormal external genitalia, mean levels of each of the measured phytoestrogen were lower; however, there was no statistical significance between the two groups (P > 0.05). Conclusions: We successfully determined and developed a novel database on the levels of measurable phytoestrogens in serum and urine from male newborns with normal external genitalia. In the normal group, a higher concentration of serum and urinary phytoestrogens was correlated with the extension of the scrotal pigmentation above and proximal to the base of the penis. These data are useful to better understand the role of phytoestrogens in the development of male genitalia and for future research on newborns with abnormal external genitalia.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"12 1","pages":"16 - 21"},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47831732","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: Hypothermia on admission in neonatal units is a well-recognized contributor of neonatal mortality and morbidity. This study aimed to identify risk factors for hypothermia on admission in a resource-poor setting which will help provide targeted preventive interventions. Methods: A retrospective cross-sectional descriptive study was conducted from July 1, 2020 to January 31, 2022. A total of 567 neonates were included in the study, data were collected from the unit electronic database. The axillary temperature of each neonate was measured using a digital thermometer at the point of admission. Bivariate and multiple logistic regressions were used to assess associated risk factors. Results: The prevalence of admission hypothermia (AH) in the study population was 42.4% with mild and moderate hypothermia accounting for 46.3% and 53.7%, respectively. Maternal ages 20–29 years (adjusted odds ratio [aOR] 0.28, 95% confidence interval [CI] 0.09–0.93) and 30–39 years (aOR 0.27, 95% CI 0.08–0.88) and primary education (aOR 0.44, 95% CI 0.21–0.92) were associated with reduced risk of AH. Age <24 h (aOR 3.61, 95% CI 1.70–7.66), gestational age 28–32 weeks (aOR 3.90, 95% CI 1.41–10.79) and 33–36 weeks (aOR 2.835, 95% CI 1.52–5.28), admission weight <2.5 kg (aOR 2.01, 95% CI 1.18–3.43), and cold season (aOR 1.85, 95% CI 1.06–3.14) were associated with increased risk of AH. Mortality in those with AH was 3 folds (crude odds ratio 3.38, 95% CI 1.6–6.82). Conclusion: Hypothermia on admission is common in neonates in resource-poor settings. Training of newborn care-providers in maintaining thermoneutral environment and temperature at delivery and postnatal periods will be a cost-effective intervention in reducing neonatal mortality.
背景:新生儿病房入院时的低温是新生儿死亡率和发病率的公认因素。本研究旨在确定在资源贫乏的环境中入院时低温症的危险因素，这将有助于提供有针对性的预防干预措施。方法:于2020年7月1日至2022年1月31日进行回顾性横断面描述性研究。本研究共纳入567例新生儿，数据来源于单位电子数据库。每个新生儿在入院时使用数字体温计测量腋窝温度。采用双变量和多重逻辑回归评估相关危险因素。结果:研究人群入院低体温(AH)患病率为42.4%，其中轻度和中度低体温分别占46.3%和53.7%。产妇年龄20-29岁(调整优势比[aOR] 0.28, 95%可信区间[CI] 0.09-0.93)、30-39岁(aOR 0.27, 95% CI 0.08-0.88)和初等教育程度(aOR 0.44, 95% CI 0.21-0.92)与AH风险降低相关。年龄<24小时(aOR 3.61, 95% CI 1.70-7.66)、胎龄28-32周(aOR 3.90, 95% CI 1.41-10.79)和33-36周(aOR 2.835, 95% CI 1.52-5.28)、入院体重<2.5 kg (aOR 2.01, 95% CI 1.18-3.43)和寒冷季节(aOR 1.85, 95% CI 1.06-3.14)与AH风险增加相关。AH患者的死亡率为3倍(粗优势比3.38,95% CI 1.6-6.82)。结论:入院时体温过低在资源贫乏地区的新生儿中很常见。培训新生儿护理人员在分娩和产后保持热中性环境和温度将是降低新生儿死亡率的一项具有成本效益的干预措施。
{"title":"Prevalence and risk factors for admission hypothermia in neonates in a Tertiary Hospital in Jos, Nigeria","authors":"U. Diala, Patience Kanhu, D. Shwe, B. Toma","doi":"10.4103/jcn.jcn_52_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_52_22","url":null,"abstract":"Background: Hypothermia on admission in neonatal units is a well-recognized contributor of neonatal mortality and morbidity. This study aimed to identify risk factors for hypothermia on admission in a resource-poor setting which will help provide targeted preventive interventions. Methods: A retrospective cross-sectional descriptive study was conducted from July 1, 2020 to January 31, 2022. A total of 567 neonates were included in the study, data were collected from the unit electronic database. The axillary temperature of each neonate was measured using a digital thermometer at the point of admission. Bivariate and multiple logistic regressions were used to assess associated risk factors. Results: The prevalence of admission hypothermia (AH) in the study population was 42.4% with mild and moderate hypothermia accounting for 46.3% and 53.7%, respectively. Maternal ages 20–29 years (adjusted odds ratio [aOR] 0.28, 95% confidence interval [CI] 0.09–0.93) and 30–39 years (aOR 0.27, 95% CI 0.08–0.88) and primary education (aOR 0.44, 95% CI 0.21–0.92) were associated with reduced risk of AH. Age <24 h (aOR 3.61, 95% CI 1.70–7.66), gestational age 28–32 weeks (aOR 3.90, 95% CI 1.41–10.79) and 33–36 weeks (aOR 2.835, 95% CI 1.52–5.28), admission weight <2.5 kg (aOR 2.01, 95% CI 1.18–3.43), and cold season (aOR 1.85, 95% CI 1.06–3.14) were associated with increased risk of AH. Mortality in those with AH was 3 folds (crude odds ratio 3.38, 95% CI 1.6–6.82). Conclusion: Hypothermia on admission is common in neonates in resource-poor settings. Training of newborn care-providers in maintaining thermoneutral environment and temperature at delivery and postnatal periods will be a cost-effective intervention in reducing neonatal mortality.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"11 1","pages":"195 - 201"},"PeriodicalIF":0.2,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45789276","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}
H. Kumar, T. Bandyopadhyay, P. Kumari, A. Maria, Swati Upadhyay
Introduction: Neonatal jaundice is a common cause of hospital admission among neonates in the 1st week of life. The condition results from an imbalance between oxidative stress and antioxidant mechanisms. Considering the fact that the metabolism of both bilirubin and 25-hydroxy Vitamin D occurs in the liver and 25-hydroxy Vitamin D being a potent antioxidant, we hypothesized that there exists an association between 25-hydroxy Vitamin D and serum bilirubin levels. Methods: A total of 174 neonates were enrolled in the study and were further subclassified into 4 groups: Group A (no clinical jaundice), Group B (clinical jaundice with the value of serum bilirubin <10 mg/dl), Group C (clinical jaundice with the value of serum bilirubin >10 mg/dl but not in phototherapy range), and Group D (clinical jaundice with serum bilirubin value requiring initiation of phototherapy). 25-hydroxy Vitamin D and serum bilirubin levels along with parathyroid hormone, calcium, phosphorus, and alkaline phosphatase levels were estimated. Results: The mean 25-hydroxy Vitamin D levels were highest in Group A and lowest in Group D (21.92 ± 20.85 vs. 14.38 ± 8.52, P = 0.020) and vice versa for serum bilirubin levels (15.08 ± 0.93 vs. 4.28 ± 0.97, P < 0.001). There was a nonsignificant negative correlation between serum 25-hydroxy Vitamin D and bilirubin levels (correlation coefficient: −0.113 [−0.257–0.0364], P = 0.138). Conclusion: The present study suggests a lack of association between serum 25-hydroxy Vitamin D and bilirubin levels. However, the results need to be confirmed by further prospective studies to conclude that 25-hydroxy Vitamin D has no role in the pathogenesis of neonatal hyperbilirubinemia.
{"title":"Association between serum 25-hydroxy Vitamin D and bilirubin levels in term neonates with hyperbilirubinemia: A cross-sectional, observational study","authors":"H. Kumar, T. Bandyopadhyay, P. Kumari, A. Maria, Swati Upadhyay","doi":"10.4103/jcn.jcn_61_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_61_22","url":null,"abstract":"Introduction: Neonatal jaundice is a common cause of hospital admission among neonates in the 1st week of life. The condition results from an imbalance between oxidative stress and antioxidant mechanisms. Considering the fact that the metabolism of both bilirubin and 25-hydroxy Vitamin D occurs in the liver and 25-hydroxy Vitamin D being a potent antioxidant, we hypothesized that there exists an association between 25-hydroxy Vitamin D and serum bilirubin levels. Methods: A total of 174 neonates were enrolled in the study and were further subclassified into 4 groups: Group A (no clinical jaundice), Group B (clinical jaundice with the value of serum bilirubin <10 mg/dl), Group C (clinical jaundice with the value of serum bilirubin >10 mg/dl but not in phototherapy range), and Group D (clinical jaundice with serum bilirubin value requiring initiation of phototherapy). 25-hydroxy Vitamin D and serum bilirubin levels along with parathyroid hormone, calcium, phosphorus, and alkaline phosphatase levels were estimated. Results: The mean 25-hydroxy Vitamin D levels were highest in Group A and lowest in Group D (21.92 ± 20.85 vs. 14.38 ± 8.52, P = 0.020) and vice versa for serum bilirubin levels (15.08 ± 0.93 vs. 4.28 ± 0.97, P < 0.001). There was a nonsignificant negative correlation between serum 25-hydroxy Vitamin D and bilirubin levels (correlation coefficient: −0.113 [−0.257–0.0364], P = 0.138). Conclusion: The present study suggests a lack of association between serum 25-hydroxy Vitamin D and bilirubin levels. However, the results need to be confirmed by further prospective studies to conclude that 25-hydroxy Vitamin D has no role in the pathogenesis of neonatal hyperbilirubinemia.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"11 1","pages":"206 - 211"},"PeriodicalIF":0.2,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47286784","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}
V. Vaddi, Medha Goyal, Dwayne Mascarenhas, A. Haribalakrishna
Fungal sepsis is a sinister infection in the neonatal intensive care unit associated with significant mortality and neurodevelopment sequelae. Very low birth weight and very preterm neonates are often predisposed and manifestations range from mucocutaneous to invasive organ involvement. Prompt recognition and treatment with appropriate antifungal improve survival and neurodevelopmental outcomes. In this report, we describe a neonate with rare dermatological manifestation in the form of a cutaneous fungal abscess with urinary tract involvement. The diagnosis was based on budding yeast cells seen on pus smear examination and culture suggestive of Candida albicans. Risk factors included birth weight <1500 g, placement of central vascular catheter, endotracheal tube, parenteral nutrition, surgical intervention, and use of broad-spectrum antibiotics. Amphotericin B deoxycholate and incision and drainage of the abscess were done to manage the abscess successfully. This report highlights the consideration of Candida as an etiological agent for cutaneous abscesses, in case of preterms with risk factors for fungal infection. Evaluation for systemic dissemination is mandatory and management with appropriate antifungal agents is critical for survival.
{"title":"Successful management of a cutaneous abscess caused by Candida albicans in a very low birth weight neonate","authors":"V. Vaddi, Medha Goyal, Dwayne Mascarenhas, A. Haribalakrishna","doi":"10.4103/jcn.jcn_36_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_36_22","url":null,"abstract":"Fungal sepsis is a sinister infection in the neonatal intensive care unit associated with significant mortality and neurodevelopment sequelae. Very low birth weight and very preterm neonates are often predisposed and manifestations range from mucocutaneous to invasive organ involvement. Prompt recognition and treatment with appropriate antifungal improve survival and neurodevelopmental outcomes. In this report, we describe a neonate with rare dermatological manifestation in the form of a cutaneous fungal abscess with urinary tract involvement. The diagnosis was based on budding yeast cells seen on pus smear examination and culture suggestive of Candida albicans. Risk factors included birth weight <1500 g, placement of central vascular catheter, endotracheal tube, parenteral nutrition, surgical intervention, and use of broad-spectrum antibiotics. Amphotericin B deoxycholate and incision and drainage of the abscess were done to manage the abscess successfully. This report highlights the consideration of Candida as an etiological agent for cutaneous abscesses, in case of preterms with risk factors for fungal infection. Evaluation for systemic dissemination is mandatory and management with appropriate antifungal agents is critical for survival.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"11 1","pages":"219 - 221"},"PeriodicalIF":0.2,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46650175","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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