ACQUIRED NEONATAL SEVERE FACTOR II DEFICIENCY- TWO CASES REPORT

In present study two cases of transient acquired and isolated factor II deficiency associated with severe bleeding are reported. Two infants were involved in severe coagulopathy. The blood clot time (CT) in case 2 was excessively prolonged over 16 hours. One-stage prothrombin time (PT) was remarkable prolonged. Haemostatic markers analysis showed an isolated deficiency of factor II at 2.5% and 4.5% respectively. No inhibitory activity against factor II could be detected. We successfully treated the deficiency with vitamin K1 during 15 days. It was interesting that in the case 2 female baby the cause of vitamin K deficiency might be breast feed problem (nutrition deficiency) and/or poor absorption from bowel. Physiopathological laboratory results and therapeutic aspects of two patients were presented. Peer Review History: Received: 1 November 2021; Revised: 9 December; Accepted: 28 December, Available online: 15 January 2022 Academic Editor: Dr. Sally A. El-Zahaby, Pharos University in Alexandria, Egypt, [email protected] UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Prof. Dr. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, [email protected] Dr. Ogbonna B. Onyebuchi, Nnamdi Azikiwe University, Awka, Nigeria, [email protected]

Investigating the disjoint between education and health policy for infant feeding among teenage mothers in South Africa: a case for intersectoral work

Background Many low-and-middle-income countries, including South Africa, have high rates of teenage pregnancy. Following the World Health Organisation recommendations, South African health policy on infant feeding promotes exclusive breastfeeding until six months of age, with gradual weaning. At the same time, South Africa’s education department, in the interest of learners, promotes adolescents’ early return to school post-partum. Yet infant feeding at school is currently not perceived as a realistic option. Methods Recognising his this policy tension, we aimed to explore how policies are interpreted and implemented by the health and education sectors through interviews with key informants who produce, interpret and implement these policies. Using an interview guide developed for this study, we conducted in-depth interviews with 24 health policy makers, managers in both sectors, school principals and nursing staff who manage adolescent mothers (aged 16-19) and their babies. Data was analysed using thematic analysis. Results Informants from both sectors expressed discomfort at pregnant learners remaining in school late in pregnancy and were uncertain about policy regarding when to return to school and how long to breast-feed. Educators reported that new mothers typically returned to school within a fortnight after delivery and that breastfeeding was not common. While health professionals highlighted the benefits of extended breastfeeding for infants and mothers, they recognised the potential conflict between the need for the mother to return to school and the recommendation for longer breastfeeding. Additionally, the need for ongoing support of young mothers and their families was highlighted. Conclusions Our findings suggest educators should actively encourage school attendance in a healthy pregnant adolescent until delivery with later return to school, and health providers should focus attention on breastfeeding for the initial 4-6 weeks postpartum, followed by guided support of formula-feeding. We encourage the active engagement of adolescents’ mothers and extended families who are often involved in infant feeding and care decisions. Education and health departments must engage to facilitate the interests of both the mother and infant: some exclusive infant feeding together with a supported return to school for the adolescent mother.

A Cross Sectional Study on Knowledge and Attitude Regarding Exclusive Breast Feeding among Women of Reproductive Age Group in Chennai, Tamil Nadu

Aim & Objectives: To assess the knowledge and attitude on exclusive breast feeding among reproductive age group women in Chennai. Materials and Methodology This is a cross sectional quantitative descriptive study. The data was collected by handing out physical questionnaire forms to volunteers or by sending a link of the google form format of the same questionnaire. The data was collected from February 2021 to September 2021. The both physical and online forms data collected were compiled with help of Microsoft Excel. These compiled data were then analyzed using SPSS 16.0 software. All the frequencies and percentages were also obtained from this. Results: In this study a total of 342 volunteers participated, all belonging to the reproductive age group i.e., 15 years to 45 years. Majority of the participants were among the age group 20 to 30 years belonging to both married and unmarried category. Out of the 342 volunteers, 74.2% (254) of the participants planned to breast feed their infants for several months. 60% of participants had scored more than 75% overall. The lowest score seen was 26/40 points. So no one in my study had low knowledge (less than 20). The knowledge percentage and attitude percentage here are 68.6% 65.4% respectively. My interpretation of the knowledge and attitude is that we need to increase the knowledge about the term “Exclusive Breast Feeding” and also encourage the mothers to breast feed their infants. Conclusion: Although most have scored more than 75%, some important questions were chosen incorrectly. This might be mostly due to the fact that there is lack of knowledge with respect to the term “exclusive” breastfeeding. This suggests that there has to be more awareness created amongst the youth population, who are tomorrow’s mothers. The need for them to know the importance of these matters lies in hands being doctors. It should be taught from school level itself.

Funding received from breastmilk substitute manufacturers and policy positions of national maternity care provider associations: an online cross-sectional review

ObjectivesMaternity care providers play an essential role in supporting women to breast feed. It is critical that their professional associations limit influence from breastmilk substitute (BMS) manufacturers. Aims of this study were (i) to examine whether maternity care provider associations had policy or positions statements addressing BMS marketing and (ii) to explore the type of funding received by these associations.DesignAn online cross-sectional review.SettingNational or regional maternity provider professional associations in Australia, New Zealand, the USA, Canada and the UK.ParticipantsTwenty-eight maternity care provider (obstetricians, midwives, nurses and others involved in perinatal care) professional association websites.InterventionsWebsites were examined from November 2019 to October 2020.Primary and secondary outcome measuresEvidence of BMS industry funding and policy or position statements addressing acceptance of funding from industries such as BMS.ResultsPolicies addressing the BMS industry were found for 14 associations (50%). UK-based associations (5/5, 100%) and perinatal associations (4/6, 67%) were most likely to have a policy. Six associations (6/28, 21%) received some form of BMS financial support. The highest rates of BMS support were seen in the form of event advertising (5/28, 18%); closely followed by event sponsorship (4/28, 14%). At a provider level, obstetric associations had the highest rates of BMS support (2/4, 50%). At a country level, US-based associations were most likely to receive BMS support (3/7, 43%).ConclusionsBMS industry financial support was received by one-fifth of maternity care provider associations. Half of these associations had policies addressing BMS marketing. BMS industry support can create conflicts of interest that can threaten efforts to support, protect and promote breast feeding. Healthcare provider associations should avoid BMS funding and at a minimum have policy or position statements addressing BMS marketing.

Information Seeking Needs of Mothers Who Bottle-Feed Their Young Infants: How the Information Seeking Process Affects Them and What Libraries Can Do to Help Them

<p>Aim: The aim of the study is to examine the information seeking experiences of mothers who bottle feed young infants. What are their information needs and how do they seek to fill them? What emotional impact does the information seeking process have on this group? What role can Libraries play in helping this group find information? Methodology: This research utilises Dervin's sense-making methodology. At the heart of sensemaking is the situation-gap-outcome triangle. Kuhlthau's uncertainty principle is also used to help analyse the results and understand the connection between emotion and information seeking. Other research is also used to understand the experiences of the interviewees and place them in a wider context. Results: Mothers who bottle-feed young infants often feel guilt and anger. They are often unprepared for bottle-feeding, especially if they planned to breast-feed, and access to information on bottle-feeding is limited. Health professionals are sometimes reluctant to provide information on bottle-feeding. Informal information sources, such as family, friends and other mothers, are very important. There is little awareness that Libraries are able to provide information on bottle-feeding even among mothers who are frequent Library users. Libraries can best support bottle-feeding mothers by becoming inclusive community spaces for mothers to meet and share information.</p>

TABOOS AND MYTHS REGARDING BREASTFEEDING PRACTICES IN PREGNANT POPULATION

Objective: To determine the taboos and myths regarding breastfeeding practices in our pregnant population. Study Design: Cross-sectional study. Place and Duration of Study: Obstetrics and Gynecology Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from May to Oct 2018. Methodology: A total of 100 pregnant women attending antenatal clinics were included in the study using non-probability purposive sampling technique. Taboos and myths regarding breast feeding practices were determined using self-administered questionnaire on 2-point Likert scale (1=agree & 2=disagree). Results: A total of 100 pregnant women participated in the study. Mean parity was 2.89 ± 1.75 and gravidity was 4.17 ± 2.04. Most of the mothers (90%) were house wives and received information regarding breast feeding from family members (81%). Mothers were aware of the nutritious value of breast milk as compared to formula milk. However, there were myths that were not evidence based. These include: breasts sag with breast feeding (48%), it is not necessary to breast feed the baby during night time (43%), breast milk alone was not sufficient to satisfy the child (51%), small size breast produce insufficient milk (27%). Conclusion: Participants of this study are aware of the importance of breast feeding. However, there are certain taboos and myths prevailing in our population which are not proven scientifically.

Feeding Twins with Human Milk and Factors Associated with Its Duration: A Qualitative and Quantitative Study in Southern Italy

Background: Over the past year, there has been a rise in twin births. The current scientific consensus recommended breast-feed milk for all newborns for at least 6 months. They stated that it is possible to meet the nutritional needs of two or more newborns with only one mother’s milk. More information would be desirable about the factors that influence or lead to the initiation and interruption of breastfeeding. The quality of the evidence available from multiple studies has been inconclusive and therefore led to controversial interpretations and practices. Aims: The first aim of this study was to analyze the extent of the feeding of multiples with breast milk in the experience of our clinical unit in terms of incidence and duration. The second objective was to evaluate the correlation between maternal, perinatal and neonatal variables with breast milk feeding rates and duration. Methods: The study was conducted between 2015 and 2020, in a NICU in Southern Italy (San Giovanni Rotondo, Foggia). Sixty-one women who have given birth to multiples were enrolled into the study. Newborn data were retrospectively collected by informatic database and breastfeeding information were collected by a questionnaire. Results: In our centre, the percentage of twins out of the total number of births over the years has almost doubled from 1.28% in 2015 to 2.48% in 2020 and the 88% of twins are premature. 18.1% received breast milk for more than 6 months and 6.3% received it for more than 12 months. Infants of lower gestational age and weight, born to multiparous, more mature and medium-high schooling mothers received breast milk for a longer period. 35% of women explained that the interruption of breastfeeding was due to the insufficient milk production and 41% to the stress and difficulties in managing the twins. Qualitative analysis of maternal narrative revealed, for many of them, the awareness of the importance of breastfeeding and the efforts made to try to give breast milk, but also fears about the quantity of milk and satiety of their children. Conclusions: It is important to identify the factors both favoring and obstructing maternal milk feeding of multiples and it would be desirable the activation of a network of training and support for mothers after discharge, with particular regard to the categories found to be less inclined.

Surgical Risk Reduction, Breast Cancer and Childbearing

Purpose of Review Young women who carry a genetic predisposition to breast cancer need to balance surgical and nonsurgical risk reducing options with childbearing. In this review, we explore how women make decisions without the benefit of official guidelines and in the context of frequently contradictory strategies. Recent Findings Women of reproductive age with known BRCA mutations receive incomplete and conflicting advice regarding the urgency and timing of risk reducing mastectomy (RRM). Those who prioritize RRM achieve highly effective prevention and thereby avoid not only a diagnosis of breast cancer but also adjuvant therapies which limit future childbearing. All reconstructive options are available and high levels of satisfaction are reported. Those who delay prophylactic mastectomy can pursue nonsurgical breast and ovarian risk reduction strategies such as tamoxifen and oral contraception, yet these delay child bearing. Women who prioritize child bearing maintain the ability to breast feed but have limited screening options during pregnancy and lactation. Summary Prioritization and timing of risk reduction and childbearing in young BRCA positive women is challenging. Elucidating these challenges enables clinicians to better counsel these women.

Use of point of care quality improvement methodology to improve newborn care, immediately after birth, at a tertiary care teaching hospital, in a resource constraint setting

After birth, separation of mothers and newborn is a common practice in many hospitals in our country. After delivery, we take the normal newborn to the radiant warmer in the resuscitation area for routine care. This was the existing process of care at our hospital. The frontline delivery team undertook quality improvement initiative to understand and document factors creating challenges in delivering evidence-based practice of providing immediate skin-to-skin care (SSC), delayed cord clamp (DCC) and early breast feeding within 1 hour of birth. Some of the barriers identified were early newborn mother separation and late transfer of mother from delivery room to the observation area. Additionally, there was a challenge of high delivery load with variation in understanding and provision of SSC and drying on mother’s abdomen. These made sustenance of improved care practices difficult. Using the Plan-Do-Study-Act (PDSA) approach some successful change ideas tested were pre-delivery counselling, avoiding separation of mother and newborn at birth by providing SSC and continuing it in the post-delivery observation area and getting family member’s help in first breast feed. The delivery team adapted these successful change ideas by multiple iterations, group discussions and feedback. This resulted in improved and sustained compliance of pre-delivery counselling, SSC, DCC and initiating breast feed within 1 hour, from minimal compliance to a median compliance of 51%, 56%, 59% and 61%, respectively, over 36 months period. We undertook this quality improvement initiative at Delhi (India) at a tertiary care teaching hospital. The implementation of WHO recommended evidence-based practices benefitted more than 10 000 mother–newborn dyads annually over 2 years, using Point of Care Quality Improvement method. Implementation of evidence-based practice is possible in challenging situations using PDSA approach. The resultant contextualised processes are convenient and have better success at sustainability.