Epidemiological, clinical and evolutionary aspects of hypotrophic newborns at term at the Mother and Child University Hospital of N'Djamena

Introduction: Hypotrophy is a public health problem in developing countries. Its etiology is multifactorial and it may be associated with high morbidity and mortality. The objective of this study was to describe the epidemiological, clinical and evolutionary profile of hypotrophic newborns at term. Methodology: this was a prospective, descriptive and analytical study conducted in the neonatology department of the MCUH of N'Djamena from 01/06/2018 to 31/05/2019. It involved 109 hypotrophic newborns at term hospitalized. Results: The frequency of hypotrophy was 7.8%, the risk factors were: housewife status (81.7%), low level of education (67%), poor pregnancy follow-up (59.7%), malaria (40.4%), urogenital infections (22%) and anemia (22%) during pregnancy. Hypotrophy was harmonious in 58.7% of cases, the sex ratio was 1.14 and visible congenital malformations were observed in 12.7% of cases. The main reasons for hospitalization were neonatal infections (64.2%), perinatal asphyxia (14.7%) and hypothermia (11.9%). Lethality was 16.5% and associated with multiparity, poor pregnancy follow-up, vaginal delivery, home delivery, pathological Apgar score, notion of resuscitation, existence of malformation, respiratory distress and perinatal asphyxia. Conclusion: Better monitoring of pregnancy, use of family planning by couples, delivery in an institutionalized setting, and reinforcement of the technical platform of the neonatology department will reduce neonatal morbidity and mortality related to hypotrophy.

A comparison of technicques to disimpact the fetal head on a second stage caesearean simulator

Background The rate of second stage caesarean section (CS) is rising with associated increases in maternal and neonatal morbidity, which may be related to impaction of the fetal head in the maternal pelvis. In the last 10 years, two devices have been developed to aid disimpaction and reduce these risks: the Fetal Pillow (FP) and the Tydeman Tube (TT). The aim of this study was to determine the distance of upward fetal head elevation achieved on a simulator for second stage CS using these two devices, compared to the established technique of per vaginum digital disimpaction by an assistant. Methods We measured elevation of the fetal head achieved with the two devices (TT and FP), compared to digital elevation, on a second stage Caesearean simulator (Desperate Debra ™ set at three levels of severity. Elevation was measured by both a single operator experienced with use of the TT and FP and also multiple assistants with no previous experience of using either device. All measurements were blinded Results The trained user achieved greater elevation of the fetal head at both moderate and high levels of severity with the TT (moderate: 30mm vs 12.5mm p<0.001; most severe: 25mm vs 10mm p<0.001) compared to digital elevation. The FP provided comparable elevation to digital at both settings (moderate: 10 vs 12.5mm p=0.149; severe 10 vs 10mm p=0.44). With untrained users, elevation was also significantly greater with the TT compared to digital elevation (20mm vs 10mm p<0.01). However digital disimpaction was significantly greater than the FP (10mm vs 0mm p<0.0001). Conclusion On a simulator, with trained operators, the TT provided greater fetal head elevation than digital elevation and the FP. The FP achieved similar elevation to the digital technique, especially when the user was trained in the procedure.

Prolonged newborns and prolong pregnancy

The article is devoted to the current problems of obstetrics, perinatology and neonatology. The article presents a literary review and covers scientific views on the factors of births and hazardous factors that lead to transfer and prolonged pregnancy. The most common perinatal complications of a delayed pregnancy are stillbirth, asphyxia, and birth trauma. Neonatal morbidity in premature infants is 29% and perinatal mortality is 19%, which is higher than in preterm infants. If the pregnancy is 43 weeks or more, these rates will increase. All of these diseases are associated with a decrease in the fetal resistance to hypoxia due to the large size of the brain and morphological changes in the placenta. Therefore, the incidence of meconium aspiration syndrome and fetal distress syndrome at birth increases, leading to high perinatal morbidity and mortality.

Look Who’s Talking: Host and Pathogen Drivers of Staphylococcus epidermidis Virulence in Neonatal Sepsis

Preterm infants are at increased risk for invasive neonatal bacterial infections. S. epidermidis, a ubiquitous skin commensal, is a major cause of late-onset neonatal sepsis, particularly in high-resource settings. The vulnerability of preterm infants to serious bacterial infections is commonly attributed to their distinct and developing immune system. While developmentally immature immune defences play a large role in facilitating bacterial invasion, this fails to explain why only a subset of infants develop infections with low-virulence organisms when exposed to similar risk factors in the neonatal ICU. Experimental research has explored potential virulence mechanisms contributing to the pathogenic shift of commensal S. epidermidis strains. Furthermore, comparative genomics studies have yielded insights into the emergence and spread of nosocomial S. epidermidis strains, and their genetic and functional characteristics implicated in invasive disease in neonates. These studies have highlighted the multifactorial nature of S. epidermidis traits relating to pathogenicity and commensalism. In this review, we discuss the known host and pathogen drivers of S. epidermidis virulence in neonatal sepsis and provide future perspectives to close the gap in our understanding of S. epidermidis as a cause of neonatal morbidity and mortality.

Knowledge and Practice Regarding Breastfeeding among Primipara Mothers of Obstetrics Ward, Birganj, Nepal

Breastfeeding is an ideal form of feeding to neonate. It is most precious gift a mother can give and is free of cost. It should be started as soon as possible after birth. Breast milk is a species-specific complete food. Human milk facilitates effortless digestion for infant and is well absorbed by the newborn. It helps in stimulating the production of breast milk, protect against infection and facilitate mother infant bonding and promotes better brain growth. For mothers breastfeeding helps in involution of uterus, delays pregnancy and lower risk of breast and ovarian cancer. Every year around 57,000 children below 5 years of age lose their lives, among which 54 percent die within the first month of life. The data stated that 22 percent of newborn death can be prevented through breastfeeding within 1st hour of birth. Mother play a very important roles in reducing neonatal mortality and neonatal morbidity rate by their knowledge and practice while feeding their baby. Method: Descriptive correlation study design was conducted in the month of August 2021 National Medical College and Teaching Hospital, Birganj, Nepal. Sample size was 50 primi para mothers. Purposive sampling techniques was used to select the sample. Semi structure interview schedule and observation checklist was prepared according to objectives which comprised questions related to demographic variables, Knowledge to assess breastfeeding and observational checklist to assess practice Data was collected by administering this structured questionnaire to the primipara mothers. Result: In the study 31 (62.0%) had adequate, 19 (38.0%) had moderate and none of them had inadequate knowledge regarding breastfeeding. 23 (46.0 had good, 27 (54.0%) had satisfactory and none of them had poor practice on breastfeeding. The results show that there was moderate degree positive correlation between knowledge and practice. Key words: Knowledge, practice, breastfeeding and primipara mothers.