Incidence and risk factors of retinopathy of prematurity in extremely low birth weight babies in a tertiary neonatal care unit in northern India

To study the incidence and risk factors of Retinopathy of prematurity in extremely low birth weight babies in a tertiary neonatal care unit in northern India. A prospective cohort study of all neonates born during January 1, 2015 to December 31, 2015, with birth weight less than 1000 grams. Demographic details, risk factors and incidence of ROP were studied. Sixty babies were enrolled for the study with mean birth weight of 892.983±112.933 (560 to 1000) grams and mean gestation age of 29.47±2.258 (25-35) weeks. The incidence of ROP in this cohort was 50% (30 infants), out of which 23% (7 infants) required treatment (laser photocoagulation). The statistical analysis of risk factors on univariate analysis revealed significant association for oxygen exposure, apnoea, surfactant use, anaemia, blood transfusion, intraventricular haemorrhage, sepsis and antibiotic use. On multivariate logistic regression analysis anemia and oxygen exposure > week were found to be independent risk factors for development of ROP. The incidence of ROP was although high in this exclusive cohort of babies born <1000g but there is substantial decrease in incidence as compared to that reported in earlier studies. Gestational age <30 wks, being appropriate for gestation rather than small for gestation, anemia and oxygen exposure>1 week were found to be independent risk factors for development of ROP in this cohort.

The Effect of Health Education on Mother's Knowledge Attitudes and Behavior in Giving Care to Low Birth Weight Babies

The number of low-birth-weight babies (LBW) who returned to the hospital after returning home had increased from 2015 to 2016. The results of the interview revealed that mothers who had LBW did not thoroughly understand providing care for LBW after returning from the hospital. This study aims to determine the effect of health education on a mother's knowledge, attitude and behaviour in providing care to LBW. This study is quasi-experimental with a pre-posttest approach non-equivalent to the control group, with 66 respondents fulfilling the inclusion criteria. The inclusion criteria in this study were post-partum mothers on the second day who had babies with a birth weight of 1500 grams-2499 grams and were willing to be respondents. The sampling technique was purposive sampling. The statistical test employed independent t-test, paired t-test, and chi-square. Knowledge scores before and after treatment were significantly different in the intervention group and control group, with a p-value in the intervention group 0.00, while the knowledge and attitude scores in the control group were 0.00 and the behavioural scores were 0.11. There was a significant difference in the increase in knowledge, attitudes and behaviour scores in both groups. The p-value of knowledge and attitudes is 0.00, and the p-value of behaviour is 0.01. Hence, there is an increase in mothers' knowledge, attitudes, and behaviour after being provided with health education using a booklet.

Folic Acid Supplementation on Fetal Growth at Different Gestational Ages

Introduction: Folate, Vitamin B9, is found naturally in our day to day foods. It is vital for synthesis of DNA and normal cell division in humans. Studies have revealed constantly that maternal folic acid[FA] intake prior to and in early conception decreases neural tube defects. Aim: The aim of the current study is to evaluate the relationship between FA intake by the mother during conception and fetal growth at different gestational ages and also if, periconceptional and preconceptional FA intake has a positive effect on fetal growth, hence reducing the risk of low birth weight babies or small for gestational age (SGA) babies. Materials and methods: 180 pregnant women were classified based on their period of FA intake as preconception, periconception FA intake and nil FA intake. Standard fetal biometric parameters were measured using ultrasonogram during the 1st , 2nd and 3rd trimester of their pregnancy. Results: Preconception FA intake had a positive effect on fetal growth as compared to those who abstained from FA supplementation. Intake during preconception and peri-conception i.e. immediately after confirmation of pregnancy was found to have a reduced risk of low fetal weight as against those who did not consume FA. Fetal biometry showed significant difference between preconception and periconception groups. Conclusion: In conclusion, preconceptional and periconceptional FA supplementation of 0.4-0.5 mg/day was positively affecting fetal growth and caused an optimal birth weight by decreasing the incidence of low birth weight.

Studi Kualitatif : Identifikasi Kebutuhan Perawatan Bayi BBLR di Rumah Dengan Pendekatan Family Centered Maternity Care

Bayi Berat Badan Lahir Rendah (BBLR) memerlukan perawatan lebih khusus dibandingkan dengan bayi lahir dengan berat badan normal, hal ini terlihat dari beberapa ibu yang kembali ke RSI Muhammadiyah Tegal karena ibu kurang memahami tentang perawatan bayi BBLR di Rumah. Family Centered Maternity Care (FCMC) adalah perawatan yang berpusat pada keluarga dengan memberikan perawatan bagi wanita dan keluarga mereka yang mengintegrasikan kehamilan, persalinan, persalinan, dan perawatan bayi ke dalam kontinum kehidupan keluarga.Tujuan penelitian ini untuk mengidentifikasi kebutuhan perawatan bayi BBLR di rumah dengan pendekatan family centered maternity care secara studi kualitatif. Penelitian dilakukan di RSI PKU Muhammadiyah Tegal. Metode dengan kualitatif dengan design studi kasus menggunakan ibu dan keluarga yang bayi BBLR sebanyak 9 orang dan focus group discussion (FGD) pada 7 perawat perinatologi. Berdasarkan hasil analisa Colaizzi didapatkan beberapa tema yaitu dukungan keluarga untuk meningkatkan kepercayaan diri ibu merawat bayi BBLR, strategi pemenuhan kebutuhan nutrisi, strategi mencegah terjadinya hipotermia, upaya mencegah terjadinya infeksi, home visit perawat. Peningkatan perhatian untuk menjaga bayi BBLR tetap hangat dalam bentuk FCMC berintergrasi pada ibu, keluarga serta perawat dapat mengoptimalkan perawatan Bayi BBLR di rumah. Kata Kunci : Bayi BBLR; family centered; maternity care, motherQualitative Study: Identification Of Low Birth Weight Baby Care Needs At Home With Family Centered Maternity Care ApproachAbstractBabies with low birth weight require more special care than babies born with normal weight; this can be seen from some mothers who return to RSI Muhammadiyah Tegal because mothers do not understand how to care for low birth weight babies at home. Family Centered Maternity Care (FCMC) is family-centered care providing care for women and their families that integrates pregnancy, childbirth, childbirth, and infant care into the continuum of family life. The purpose of this study was to identify the care needs of low birth weight baby at home with a family centered maternity care approach in a qualitative study. The research was conducted at Muhammadiyah Hospital Tegal. Qualitative method with case study design was used in 9 mothers and families of low birth weight babies and focus group discussion on 7 perinatology nurses. Based on the results of Colaizzi's analysis, several themes were found, namely family support to increase mother's confidence in caring for low birth weight babies, strategies to fulfill nutritional needs, strategies to prevent hypothermia, efforts to prevent infection, nurse home visits. Increased attention to keeping low birth weight babies warm in the form of Family Centered Maternity Care with interaction with mothers, families and nurses can optimize the care of low birth weight babies at home. Keywords: low birth weight babies; family center; maternity care; mother

Hypophosphatemia and Metabolic Bone Disease Associated With the Use of Elemental Formula: Case Report and Review

A small percentage of infants and children develop cow’s milk protein allergy which is usually treated with exclusive breastfeeding or extensively hydrolyzed formulas. Some children might still be reactive to hydrolyzed formulas and would need elemental amino acid-based formulas. Elemental formulas are also frequently employed in treating very low birth weight babies with significant intolerance to regular preterm formulas and the resulting poor growth. All pediatric formulas are usually prepared as per international guidelines to fulfill the macro- and micronutrient requirements of growing children across a wide range of volume intakes. However, an interesting correlation is being reported recently, between the use of a specific elemental formula and the development of hypophosphatemia and significant metabolic bone disease. We discuss this phenomenon by exploring the available evidence and report 2 similar cases that we managed in our practice.

Exclusive and Dual Cigarette and Hookah Smoking Is Associated with Adverse Perinatal Outcomes among Pregnant Women in Cairo, Egypt

This study assessed the prevalence of prenatal smoking, factors associated with prenatal smoking, and its association with birth outcomes in a sample of pregnant women in Egypt. Pregnant women were recruited during their last trimester from antenatal clinics in Cairo from June 2015 to May 2016. Participants completed an interviewer-administered survey that assessed tobacco use and attitudes, and exhaled carbon monoxide (CO) was measured. Gestational age at delivery and offspring birth weight were collected via a postnatal phone interview. Two hundred pregnant women ages 16–37 years participated. More than a quarter (29.0%) of women reported smoking (cigarettes, hookah, or both) during their current pregnancy, and hookah was more popular than cigarettes. Most women who smoked prior to their current pregnancy either maintained their current smoking habits (46.6%) or switched from dual to hookah-only smoking (46.6%). Current smokers during pregnancy had a higher mean (±SD) exhaled CO level (2.97 ± 1.45 vs. 0.25 ± 0.60 ppm, p < 0.001) and had babies with a lower mean birth weight (2583 ± 300 vs. 2991 ± 478 g, p < 0.001) than non-smokers. Smokers during pregnancy had greater odds of premature birth and/or low birth weight babies compared to non-smokers. Dual cigarette-hookah smokers had the highest risk. Additional focused programs are required to prevent women of childbearing age from initiating tobacco use and empower women to stop tobacco use during the preconception and gestational periods.

Early full enteral feeding in very low birth weight babies on day one

Background: Nutrition in very low birth weight babies is most important factor in early improvement of neonate. It also decides duration of stay in intensive care unit. Objectives of the current study were to initiate required full enteral feed at the earliest and to know the outcome of such neonates.Methods: It is a hospital based retrospective study conducted from October 2019 to December 2019 in Gulbarga institute of medical sciences, Kalaburagi. 40 clinically stable VLBW neonates on day 1 started on enteral feeding are included in the study. Babies with birth weight more than 1.5 kgs or less than 1 kg, hemodynamically unstable at start of feeds are excluded from the study. Collected data is analysed by SPSS 17.Results: Total 40 VLBW babies were included in the study. Among them, 28 neonates tolerated feeds, were improved & discharged early with an average duration of stay of 16days with early birth weight gain by 14 days. 10 neonates had feed intolerance with signs of Necrotizing enterocolitis during course of treatment, were improved and discharged with an average duration of stay of 22 days. Mortality was seen in 2 neonates due to associated sepsis. Conclusions: Initiation of full enteral feeds in stable VLBW babies is effective mode for improvement, weight gain and early discharge from hospital.

Foot length as a surrogate maker to identify birth weight

Background: Gestational age and birth weight is an important predicator for morbidity and mortality in neonates. Aim was to determine the correlation of foot length with birth weight and gestational age in neonates.Methods: This was a prospective observational study done in the neonatal unit department of pediatrics in Chirayu medical college and hospital, Bhopal. There were 1739 deliveries included during the study period from January 2016 to December 2020. Study group comprised of all live born babies delivered in within 24 hours of birth who fulfilled the inclusion criteria.Results: The study comprised of 1739 newborn babies, out of which 896 (51.51%) were males and 843 (48.49%) were females. Male:female ratio 1.06:1. In our study group, 337 (15.6%) babies were preterm and 1385 (84.39%) were of term gestation. We found a positive linear correlation of foot length with all birth weight groups in a newborn with a correlation coefficient (r=0.78) and p<0.001 was found. Similarly, a positive correlation of foot length and gestational age of newborn in both term and preterm babies with (r=0.83) with p<0.01. Foot length has 87.4% sensitivity and 91.7% specificity among low-birth-weight babies with respect to cut off foot length of 75.5 mm. Foot length has 78.7% sensitivity and 63.7% specificity among preterm babies.Conclusions: Foot length can be used as a screening tool to identify low birth weight (LBW) and preterm babies as it had a higher sensitivity and specificity.

Neurodevelopmental outcome of very low birth weight and extremely low birth weight newborn at 12 months of corrected age associated with prenatal risk factors

Background: Various neuro-developmental impairment (NDI) among very low birth weight babies (VLBW) and extremely low birth weight (ELBW) babies are common in Indian scenario. This study was designed to assess the impact between prenatal risk factors and neuro-developmental outcomes of premature infants.Methods: This descriptive study was conducted on 143 VLBW and ELBW babies admitted in SNCU of North Bengal Medical College, Darjeeling, West Bengal and discharged babies were followed up.Results: Total 143 neonates were studied among male 82 (57.3%) and female 61 (42.7%) and AGA: SGA ratio was 1.97. Birth weight ranged from 500 to 1500grams with mean was 1199.6±244.14 and the median was 1240 gm. The mean gestational age (Mean± SD) was 29.65±2.032 weeks with range 24-32 weeks and the median was 30 weeks. 28 (19.6%) had PIH, 39 (27.3%) had multiple gestation, 18 (12.6%) had perinatal infection and 25 (17.5%) had birth asphyxia. CRIB II score ranged from 3-18 with mean was 8.021±3.883 and median was 7. 73.4% (105/143) were discharged alive. Significant positive correlations were found among birth weight, gestational age, perinatal infection (p<0.001). Adverse neonatal outcome was associated with CRIB II score ≥10. Total CRIB II score with parameters of NDI like developmental delay, cerebral palsy, visual abnormality, absent ABR showed good correlation (p<0.001). Fisher Exact test revealed significant association between total score and Cerebral palsy (p=0.0005), visual abnormality (p=0.0005), absent ABR (p=0.0002).Conclusions: Perinatal risk factors influence future NDI in very low and extremely low birth weight babies. They should be identified and treated promptly to achieve good outcome.

Attaining Sustainable Development Goal for Newborn Survival: Reinforcing Postnatal Interventions

Under the sustainable development goals (SDG), the target for neonatal mortality rate (NMR) was proposed to be less than 12 per 1000 live births by 2030 and may not meet the SDG 2030 NMR target. It may be prudent to focus on moderately low birth weight babies, 1500-2499 g, to reach the goal. This category of babies constitutes 37% of newborn deaths. They need supervised care for a short period that consists of the provision of warmth and breastfeeding with or without antibiotic therapy, and with or without oxygen administration. Despite knowing that these interventions can reduce neonatal deaths, deficiencies in how to implement these measures may be making all the difference to the expected outcome. This paper suggests possible ways to enhance the effectiveness of some of the better-known interventions such as the provision of warmth, feeding, resuscitation, oxygen administration, delivery of continuous positive airway support, and antibiotic therapy.