scholarly journals Caregivers Perspective Towards Use of Enteral Lactoferrin Supplementation In Newborn Infants; Formative Research Findings

2021 ◽  
Author(s):  
Shabina Ariff ◽  
Sajid Soofi ◽  
Almas Aamir ◽  
Saleema Khowaja ◽  
Javairia Khalid ◽  
...  
Keyword(s):  
Low Birthweight ◽  
Newborn Infants ◽  
Newborn Care ◽  
University Hospital ◽  
Bovine Lactoferrin ◽  
Care Seeking ◽  
Optimal Method ◽  
Main Trial ◽  
Feeding Method ◽  
Developmental Problems

Abstract Background: Infection is the second most leading cause of neonatal deaths in Pakistan. Lactoferrin is a naturally occurring protein found in human milk which can prevent neonatal infections and improve the survival of high-risk, low birth weight newborns. Bovine lactoferrin (bLF) has been recognized as a safe nutrient with no adverse effects. The aim of this study was to explore routine newborn care practices, care seeking attitudes, and assess the acceptability and the optimal method of administering bLF at the household level.Method: Exploratory qualitative research design was adopted. Thirty in-depth interviews with mothers, grandmothers and fathers of low birthweight (LBW) infants were conducted at postnatal wards and the neonatal intensive care unit (NICU) of the Aga Khan University Hospital. Eleven of these families were also recruited for a trial of improved practices (TIPs) to assess the feasibility and the method of administration of bLF prior to the main trial. Interviews were recorded and analyzed using thematic analysis.Result: Most study participants consider birthweight as a predictor of neonatal health outcomes. Caring of LBW newborns was identified as a physically and emotionally overwhelming experience. Majority of mothers believed that LBW babies are prone to infections, gastrointestinal, respiratory and developmental problems. Fathers and grandmothers were major decision makers in the family and supported the use of bLF in LBW newborns. Parents, who used bLF were satisfied with feeding method and frequency of bLF. Conclusion: Our formative study found that participants were willing to use bLF for feeding LBW babies. However, educating mothers, fathers and grandmothers is crucial for successful uptake of the intervention. Bovine lactoferrin is a safe and easy to administer according caregivers of LBWs babies. It also has potential to be translated into a safe and effective intervention for LBW babies to prevent sepsis.Trial registration: ClinicalTrials.gov identifier: NCT03431558.

scholarly journals Evidence-based interventions to reduce mortality among preterm and low-birthweight neonates in low-income and middle-income countries: a systematic review and meta-analysis

2021 ◽  
Vol 6 (2) ◽  
pp. e003618
Author(s):  
Mirjam Y Kleinhout ◽  
Merel M Stevens ◽  
Kwabena Aqyapong Osman ◽  
Kwame Adu-Bonsaffoh ◽  
Floris Groenendaal ◽  
...  
Keyword(s):  
Low Income ◽  
Low Birthweight ◽  
Meta Analysis ◽  
Neonatal Resuscitation ◽  
Newborn Care ◽  
Evidence Based ◽  
Antenatal Corticosteroids ◽  
Essential Newborn Care ◽  
Middle Income ◽  
Middle Income Countries

BackgroundPreterm birth is the leading cause of under-five-mortality worldwide, with the highest burden in low-income and middle-income countries (LMICs). The aim of this study was to synthesise evidence-based interventions for preterm and low birthweight (LBW) neonates in LMICs, their associated neonatal mortality rate (NMR), and barriers and facilitators to their implementation. This study updates all existing evidence on this topic and reviews evidence on interventions that have not been previously considered in current WHO recommendations.MethodsSix electronic databases were searched until 3 March 2020 for randomised controlled trials reporting NMR of preterm and/or LBW newborns following any intervention in LMICs. Risk ratios for mortality outcomes were pooled where appropriate using a random effects model (PROSPERO registration number: CRD42019139267).Results1236 studies were identified, of which 49 were narratively synthesised and 9 contributed to the meta-analysis. The studies included 39 interventions in 21 countries with 46 993 participants. High-quality evidence suggested significant reduction of NMR following antenatal corticosteroids (Pakistan risk ratio (RR) 0.89; 95% CI 0.80 to 0.99|Guatemala 0.74; 0.68 to 0.81), single cord (0.65; 0.50 to 0.86) and skin cleansing with chlorhexidine (0.72; 0.55 to 0.95), early BCG vaccine (0.64; 0.48 to 0.86; I2 0%), community kangaroo mother care (OR 0.73; 0.55 to 0.97; I2 0%) and home-based newborn care (preterm 0.25; 0.14 to 0.48|LBW 0.42; 0.27 to 0.65). No effects on perinatal (essential newborn care 1.02; 0.91 to 1.14|neonatal resuscitation 0.95; 0.84 to 1.07) or 7-day NMR (essential newborn care 1.03; 0.83 to 1.27|neonatal resuscitation 0.92; 0.77 to 1.09) were observed after training birth attendants.ConclusionThe findings of this study encourage the implementation of additional, evidence-based interventions in the current (WHO) guidelines and to be selective in usage of antenatal corticosteroids, to reduce mortality among preterm and LBW neonates in LMICs. Given the global commitment to end all preventable neonatal deaths by 2030, continuous evaluation and improvement of the current guidelines should be a priority on the agenda.

Staphylococcal Infections

PEDIATRICS ◽  
1956 ◽  
Vol 18 (2) ◽  
pp. 336-336
Author(s):  
THOMAS E. SHAFFER
Keyword(s):  
Phage Type ◽  
Newborn Infants ◽  
Ohio State University ◽  
University Hospital ◽  
State University ◽  
Single Strain ◽  
Staphylococcal Infections ◽  
Nursing Mothers

In the recent epidemic of staphylococcal infections in the newborn nurseries at Ohio State University Hospital, a single strain of Micrococcus pyogenes, phage type 42B-47C-44A-52, was found to be responsible for all lesions. A report of this epidemic is to be published in Pediatrics (Schaffer, T. E., Baldwin, J. N., Rheins, M.S., and Sylvester, R. L., Jr.: Staphylococcal infections in newborn infants: I. A study of an epidemic among infants and nursing mothers). Since that time we have had opportunities to study organisms responsible for similar epidemics among newborns and nursing mothers in Portsmouth and Lancaster, Ohio; Lepeer, Michigan; Seattle, Washington; Hartford, Wisconsin; and Philadelphia, Pennsylvania, and have found that in every instance phage type 42B-47C-44A-52 was responsible.

scholarly journals Community-Based Cluster Randomized Controlled Trial: Empowering Households to Identify and Provide Appropriate Care for Low-Birthweight Newborns in Nepal

2020 ◽  
Author(s):  
Stephen Hodgins ◽  
Binamra Rajbhandari ◽  
Deepak Joshi ◽  
Bharat Ban ◽  
Subarna Khatry ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Low Birthweight ◽  
Controlled Trial ◽  
Care Seeking ◽  
Apparent Effect ◽  
Community Based ◽  
Randomized Controlled ◽  
Appropriate Care ◽  
Cluster Randomized ◽  
Skin To Skin

Abstract Background: Most newborn deaths occur among those of low birthweight (LBWt), due to prematurity &/or impaired fetal growth. Simple practices can mitigate this risk. In low-income country settings where many births occur at home, strategies are needed that empower mothers to determine if their babies are higher risk and take protective measures. Earlier studies suggest that foot-length may be a good proxy for birthweight. An earlier Nepal study found a 6.9cm cut-off performed relatively well, differentiating normal from low birthweight.Methods: Community-based, cluster-randomized controlled trial. Objective: to determine whether family-administered screening, with targeted messages improves care practices known to mitigate LBWt risks. Participants: pregnant women participating in a parent trial in rural Nepal. Women were given a 6.9cm card to assess whether the baby’s foot is small; if so, to call number on the card for advice. Follow-up visits were made over 2 weeks following the birth, assessing for: reported skin-to-skin thermal care, and care-seeking outside the home; restricting to low birthweight (using 2 cutoffs: 2,500g and 2,000g). Randomization: 17 clusters intervention, 17 control. The study also documented steps along the presumed causal chain from intervention through behavioral impact.Results: 2,022 into intervention, 2,432 into control. Intervention arm: 519 with birthweight <2,500g (vs. 663 among controls), of which 503 were available for analysis (vs. 649 among controls). No significant difference on care-seeking; for those <2,500g RR 1.13 (95%CI: 0.97-1.131). More of those in the intervention arm reported skin-to-skin thermal care than among controls; for those <2,500g RR 2.50 (95%CI: 2.01-3.1). Process measures suggest this apparent effect cannot be attributed to the intervention; the card performed poorly as a proxy for LBWt, misclassifying 84.5% of those <2,000 as normal.Conclusions: Although the trial found an apparent effect on one key behavioral outcome, this cannot be attributed to the intervention; most likely it was a result of pure chance. Other approaches are needed for identifying at-risk babies in such settings, and targeting them for appropriate care messaging.Trial registration : clinicaltrials.gov identifier: NCT02802332, registered 16 June 2016, https://clinicaltrials.gov/ct2/show/NCT02802332

scholarly journals A profile on the spectrum of neonatal mortality and morbidity pattern of extramural neonates in the Specialised Neonatal Care Unit (SNCU) in a tertiary care hospital

2018 ◽  
Vol 5 (2) ◽  
pp. 427 ◽  
Author(s):  
Anuradha D. ◽  
Rajesh Kumar S. ◽  
Aravind M. A. ◽  
Jayakumar M. ◽  
J. Ganesh J.
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Respiratory Distress ◽  
Neonatal Mortality ◽  
Low Birthweight ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Newborn Care ◽  
Care Hospital ◽  
Neonatal Deaths

Background: Every year, nearly four million newborn babies die in the first month of life. India carries the single largest share (around 25-30%) of neonatal deaths in the world. Neonatal deaths constitute two thirds of infant deaths in India. 45% of the deaths occur within the first two days of life. It has been estimated that about 70% of neonatal deaths could be prevented if proven interventions are implemented effectively at the appropriate time. It was further estimated that health facility-based interventions can reduce neonatal mortality by 23-50% in different settings. Facility-based newborn care, thus, has a significant potential for improving the survival of newborns in India. This research has been planned with an aim to study the profile of pattern of admissions in a SNCU and their outcomes following admission and management in the unit.Methods: All babies referred for neonatal problems (less than 28 days) and admitted in NICU will be included. Both term and preterm babies will be considered. The criteria for admission includes various causes like low birth weight, preterm, birth asphyxia, respiratory distress, hyperbilirubinemia, congenital anomalies, risk factors (maternal, neonatal, prenatal), infections and outcome will be analysed.Results: Among the 2927 admissions term babies and boys outnumbered. The common causes for admission were birth asphyxia, respiratory distress, low birthweight and preterm. Most babies had an uncomplicated stay. The mortality in the extramural neonates was due to neonatal sepsis, extreme preterm and congenital malformations.Conclusions: Intensive and interventional management, along with good neonatal monitoring and care can reduce the mortality and improve the survival of low birth weight babies and other treatable problems. Thus, a combined effort of management by pediatricians, nursing care, neonatal intensive care unit can improve the survival rates of neonates.

scholarly journals Protocol for the Lactoferrin Infant Feeding Trial (LIFT): a randomised trial of adding lactoferrin to the feeds of very-low birthweight babies prior to hospital discharge

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023044 ◽  
Author(s):  
Andrew Martin ◽  
Alpana Ghadge ◽  
Paolo Manzoni ◽  
Kei Lui ◽  
Rebecca Brown ◽  
...  
Keyword(s):  
Brain Injury ◽  
Hospital Discharge ◽  
Low Birthweight ◽  
Late Onset ◽  
Randomised Trial ◽  
Control Group ◽  
Bovine Lactoferrin ◽  
Very Low Birthweight ◽  
End Point ◽  
Late Onset Sepsis

IntroductionVery-low birthweight (VLBW, <1500 g) infants comprise about 1%–1.4% of all births in high-income countries. Every year, about 3000 VLBW babies in Australia and New Zealand receive intensive care. Many die or else survive with severe brain injury, retinopathy, late-onset sepsis or necrotising enterocolitis (NEC), each of which carries substantial risk of disability.Methods and analysisThis trial tests whether adding bovine lactoferrin (bLF) to feeds in VLBW infants improves (1) survival to hospital discharge free from brain injury, late-onset sepsis, NEC and treated retinopathy of prematurity (primary composite end point); (2) each component of the primary composite end point and (3) time to reach full enteral feeds, number of blood transfusions, chronic lung disease and length of hospital stay. It includes a cost-effectiveness analysis of bLF in improving survival free from major morbidity, and evaluates the effect of bLF on survival and developmental outcomes at 24 to 36 months corrected gestational age.This is a multicentre, two-arm, randomised trial comparing the treatment group receiving bLF added to breast milk or formula milk daily (up to 250 mg/kg/day bLF) versus the control group receiving no bLF supplementation. The intervention is administered until 34 completed weeks corrected gestation or for 2 weeks, whichever is longer, or until discharge home, if earlier. The target sample size of 1500 participants yields 85% power, at the two-sided 5% level significance, to detect a difference in proportions meeting the primary outcome assuming the true probability is 74% in controls and 80.5% in the bLF group.Ethics and disseminationThis protocol was approved by Northern Sydney Local Human Research Ethics Committee in January 2017 (Version 2.0, Reference 1003-118M) and other relevant ethics committees. The findings of the trial will be disseminated through peer-reviewed journals and conference presentations.Trial registration numberACTRN12611000247976; Pre-results.

scholarly journals Mid-arm and Chest Circumferences for Estimating Low Birthweight

2018 ◽  
Vol 33 (1-2) ◽  
pp. 24-31
Author(s):  
Achmad Surjono
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Low Birthweight ◽  
Newborn Infants ◽  
Roc Curves ◽  
Strong Correlations ◽  
Significant Difference ◽  
A Prospective Study

A prospective study was conducted to assess the diagnostic performance of mid-arm and chest circumferences on low birth weights in 1033 singleton newborn infants. The proportion of low birth weight was 11.7%. Strong correlations on birth weight (P<0.001) were found for mid-arm (r-0.85) and chest (r=0.86) circumferences. A mid-arm circumference of ≤9,5 cm was considered as cut-off level for low birth weight, with a sensitivity of 0.818, specificity 0.956 and positive predictive value 0. 712. Whereas that of chest circumference wa ≤29.5 cm with a sensitivity of 0. 785, specificity 0.895 and positive predictive value 0.497. Receiver operating characteristic (ROC) curves were used to compare their diagnostic accuracy. The area under these two ROC(± SE) were 0.954 ± 0.011 for mid-arm and 0.945 ± 0.012 for chest circumferences, respectively. Both areas showed significant differences with the area under chance line. No statistically significant difference was found between the area under ROC of mid-arm and chest circumferences. The results showed that mid-arm and chest circumferences as simple and reliable measurements can be used in estimating low birth weight, in areas where the accurate weighing of newborn infants is not feasible.

scholarly journals Effects of eye cover among high risk neonates at night shift on their distress levels

2019 ◽  
Vol 9 (7) ◽  
pp. 9
Author(s):  
Eman Ali Moselhi Mater ◽  
Huda Shawky Mahamud ◽  
Mohamed Farouk Mohamed
Keyword(s):  
High Risk ◽  
Night Shift ◽  
Newborn Infants ◽  
Study Groups ◽  
University Hospital ◽  
Control Group ◽  
Stressful Environment ◽  
Distress Level ◽  
Significant Difference ◽  
The Mean

Background and aim: The Neonatal Intensive Care Unit (NICU) is a stressful environment for high risk neonates. Persistent bright light is one of the main environmental stressors that are distressed newborn infants in NICU. Cycled lighting may decrease distress level of newborn infants by enhancing calming status. This study aimed to investigate effects of eye cover among high risk neonates at night shift on their distress levels.Methods: Quasi experimental research design was carried out on a randomized sample of 60 newborn infants attending the NICU of El Manial University Hospital (Kasr Al Ainy), (30 control group and 30 study group). Neonatal assessment tool and COMFORTneoNRS scale were utilized for data collection.Results: There was a statistically significant difference between control and study groups regarding the distress levels (p < .00). The mean score of distress levels were 6.80 ± 1.80 and 0.80 ± 1.15 respectively and the mean score of comfort levels in the newborn infants in the control and study groups were 23.22 ± 5.50 and 6.60 ± 1.06 respectively. Eye coved enhanced quite sleep (66.7%), relaxed muscle (73.3%), decrease movement (66.7%) and no crying (85.7%).Conclusions: The use of eye cover among high risk neonates at night shift is effective to decrease their distress level and improve their comfort state in the morning shift by promoting quite sleep and relaxation. Recommendations: The educational program is needed to raise awareness among neonatal nurses about the effect of light reduction methods such as eye patches on the distress level and comfort state that enhances the growth and development of newborn infants.

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