1
|
Hashmi A, Darakamon MC, Aung KK, Mu M, Misa P, Jittamala P, Chu C, Phyo AP, Turner C, Nosten F, McGready R, Carrara VI. Born too soon in a resource-limited setting: A 10-year mixed methods review of a special care baby unit for refugees and migrants on the Myanmar-Thailand border. Front Public Health 2023; 11:1144642. [PMID: 37124770 PMCID: PMC10130587 DOI: 10.3389/fpubh.2023.1144642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Background Preterm birth is a major public health concern with the largest burden of morbidity and mortality falling within low- and middle-income countries (LMIC). Materials and methods This sequential explanatory mixed methods study was conducted in special care baby units (SCBUs) serving migrants and refugees along the Myanmar-Thailand border. It included a retrospective medical records review, qualitative interviews with mothers receiving care within SCBUs, and focus group discussions with health workers. Changes in neonatal mortality and four clinical outcomes were described. A mix of ethnographic phenomenology and implementation frameworks focused on cultural aspects, the lived experience of participants, and implementation outcomes related to SCBU care. Results From 2008-2017, mortality was reduced by 68% and 53% in very (EGA 28-32 weeks) and moderate (EGA 33-36 weeks) preterm neonates, respectively. Median SCBU stay was longer in very compared to moderate preterm neonates: 35 (IQR 22, 48 days) vs. 10 days (IQR 5, 16). Duration of treatments was also longer in very preterm neonates: nasogastric feeding lasted 82% (IQR 74, 89) vs. 61% (IQR 40, 76) of the stay, and oxygen therapy was used a median of 14 (IQR 7, 27) vs. 2 (IQR 1, 6) days respectively. Nine interviews were conducted with mothers currently receiving care in the SCBU and four focus group discussions with a total of 27 local SCBU staff. Analysis corroborated quantitative analysis of newborn care services in this setting and incorporated pertinent implementation constructs including coverage, acceptability, appropriateness, feasibility, and fidelity. Coverage, acceptability, and appropriateness were often overlapping outcomes of interest highlighting financial issues prior to or while admitted to the SCBU and social issues and support systems adversely impacting SCBU stays. Interview and FGD findings highlight the barriers in this resource-limited setting as they impact the feasibility and fidelity of providing evidence-based SCBU care that often required adaptation to fit the financial and environmental constraints imposed by this setting. Discussion This study provides an in-depth look at the nature of providing preterm neonatal interventions in a SCBU for a vulnerable population in a resource-limited setting. These findings support implementation of basic evidence-based interventions for preterm and newborn care globally, particularly in LMICs.
Collapse
Affiliation(s)
- Ahmar Hashmi
- Institute for Implementation Science, University of Texas Health Sciences Center (UTHealth), Houston, TX, United States
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Sciences Center (UTHealth), Houston, TX, United States
| | - Mu Chae Darakamon
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Ko Ko Aung
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mu Mu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Prapatsorn Misa
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | | | - Cindy Chu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Aung Pyae Phyo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Claudia Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Verena I. Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- *Correspondence: Verena I. Carrara
| |
Collapse
|
2
|
Zhuo Q, Xu JB, Zhang J, Ji B. Effect of active and passive warming on preventing hypothermia and shivering during cesarean delivery: a systematic review and meta-analysis of randomized controlled trials. BMC Pregnancy Childbirth 2022; 22:720. [PMID: 36131231 PMCID: PMC9494806 DOI: 10.1186/s12884-022-05054-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Perioperative hypothermia and shivering commonly occur in pregnant women undergoing cesarean section. The warming method is usually used to prevent hypothermia and shivering. However, the effect of active warming (AW) prior to passive warming (PW) on the perioperative outcomes of pregnant women and their offspring remains controversial. Methods This study aimed to investigate the effects of AW and PW on maternal and newborn perioperative outcomes during cesarean delivery. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PubMed, Embase, Scopus, and the Cochrane Library were used to search for randomized controlled trials (RCTs) up to August 7, 2022. The Cochrane risk of bias assessment tool was used to assess articles selected for the systematic review. Continuous data were analyzed using weighted mean differences (WMDs) with 95% confidence intervals (CIs), and categorical data were analyzed by the random-effects model. Results A total of 1241 participants from twelve RCTs were selected for the final meta-analysis. AW was associated with a lower risk of maternal hypothermia (RR: 0.77, 95% CI: 0.63–0.93, P = 0.007) and shivering (RR: 0.56, 95% CI: 0.37–0.85; P = 0.007). AW was associated with high maternal temperature (WMD: 0.27, 95%CI: 0.14 to 0.40, P < 0.001). No significant difference was observed between AW and PW in terms of hypothermia (RR: 0.60, 95% CI: 0.24–1.51, P = 0.278), temperature (WMD: 0.31, 95% CI: − 0.00 to 0.62; P = 0.050), and umbilical vein PH in newborns (WMD: -0.00; 95% CI: − 0.02 to 0.02, P = 0.710). Conclusions These findings suggested that AW can better prevent maternal hypothermia and shivering than PW. In contrast, no significant effect was observed in newborns. Overall, the quality of the included studies is high due to RCTs, low risk of bias, consistency, and precision. We identified the quality of the overall evidence from the survey to be GRADE I. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05054-7.
Collapse
Affiliation(s)
- Qing Zhuo
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jia-Bin Xu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jing Zhang
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Bin Ji
- Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
3
|
Glenn T, Price R, Culbertson L, Yalcinkaya G. Improving thermoregulation in transported preterm infants: a quality improvement initiative. J Perinatol 2021; 41:339-345. [PMID: 32678317 PMCID: PMC7860135 DOI: 10.1038/s41372-020-0732-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/16/2020] [Accepted: 07/07/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Increase the percentage of transported preterm or LBW infants with an admission temperature of 36.5-37.5 °C from 60 to 80% by December 2017. STUDY DESIGN We used the Model for Improvement with Plan-Do-Study-Act (PDSA) cycles. Interventions focused on awareness of temperature control in preterm infants, adequate monitoring, and maintaining normothermia. Interventions consisted of standardizing isolette temperature, use of chemical warming pack and plastic wrap, and feedback. Data were plotted on a p-chart and grouped by month. RESULT A total of 381 infants <37 weeks or <2.5 kg were transported from January 2016 to December 2019. At baseline 60% were admitted with a temperature within the range of 36.5-37.5 °C. Special cause variation was noted twice during the study period, initially to 80% in June 2018 and then to 96% in April 2019, without an increase in hyperthermia. CONCLUSION Multidisciplinary quality improvement efforts improved normothermia in vulnerable transported infants to 96%.
Collapse
Affiliation(s)
- Tara Glenn
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
| | - Rhonda Price
- Department of Emergency Services, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Lauren Culbertson
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Gulgun Yalcinkaya
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| |
Collapse
|
4
|
McKnight SM, Simmons RM, Wu G, Satterfield MC. Maternal arginine supplementation enhances thermogenesis in the newborn lamb. J Anim Sci 2020; 98:5819648. [PMID: 32283549 DOI: 10.1093/jas/skaa118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/09/2020] [Indexed: 01/02/2023] Open
Abstract
Body temperature maintenance is one of the most important physiological processes initiated after birth. Brown adipose tissue (BAT) is an essential mediator of thermogenesis in many species and is responsible for 50% of the heat generated in the newborn lamb. To determine if maternal arginine supplementation could enhance thermogenesis in the neonate, we randomly assigned 31 multiparous Suffolk ewes, gestating singletons or twins, to receive intravenous injections of either l-arginine (27 mg/kg body weight; n = 17) or sterile saline (n = 14) three times daily from day 75 to 125 of gestation (term = 147). Following parturition, lambs were removed from their mothers and subjected to 0 °C cold challenges at 4 and 22 h of age. Rectal temperatures were higher for the duration of the cold challenges in lambs from arginine-treated ewes compared with lambs from saline-treated ewes (P < 0.05). Elevated rectal temperatures were associated with increased (P < 0.05) circulating glycine and serine concentrations in lambs. The mRNA expression of genes related to BAT function changed over time, but not between lambs from arginine-treated vs. saline-treated ewes. Results indicate that maternal arginine treatment increases neonatal thermogenesis after birth. Although the underlying mechanisms remain to be elucidated, these data are a first step in improving neonatal survival in response to cold.
Collapse
Affiliation(s)
- Sorin M McKnight
- Department of Animal Science, Texas A&M University, College Station, TX
| | - Rebecca M Simmons
- Department of Animal Science, Texas A&M University, College Station, TX
| | - Guoyao Wu
- Department of Animal Science, Texas A&M University, College Station, TX
| | | |
Collapse
|
5
|
Merazzi D, Bresesti I, Tagliabue P, Valsecchi MG, De Lorenzo P, Lista G. Body temperature at nursery admission in a cohort of healthy newborn infants: results from an observational cross-sectional study. Ital J Pediatr 2020; 46:46. [PMID: 32293526 PMCID: PMC7157981 DOI: 10.1186/s13052-020-0810-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exposure to hypothermia is somehow unavoidable when a baby comes to life. This is the reason why any possible effort should be made by every caregiver involved during birth, from labour to transfer into the maternity ward, to reduce it. Hypothermia has widely shown to be related to several neonatal problems, and the risks are more relevant when the babies are born prematurely. METHOD An observational study was conducted in April 2016 to assess the current practises to avoid hypothermia at birth in 20 Italian neonatal units. Each unit introduced local improvements in clinical practice and the same observational study was repeated 1 year later. RESULTS A total of 4722 babies were analysed. An overall increase in adherence to local and international recommendations emerged from our study. Significant differences between 2016 and 2017 were found in regard to neonatal temperature at nursery entry (36.3 °C vs 36.5 °C, respectively, p < 0.0001), delayed cord clamping practice > 60″ (48.1% vs 68.1%, respectively, p < 0.0001) and skin-to-skin practice > 60' (56.3% vs 60.9, respectively, p = 0.03). Statistical correlations with the risk of hypothermia were found for delivery room (OR 0.88 (CI 95%0.83-0.94), p < 0.0001) and maternal temperature (OR 0.57 (CI 95% 0.48-0.67), p < 0.0001). CONCLUSION Periodical assessment of the delivery room practice has shown to be effective in improving adherence to the international recommendations. Relationship between neonatal hypothermia and several other variables including the delivery room and mother temperature underlines how neonatal thermoregulation starts immediately after birth. Hence, a multi-disciplinary approach is needed to provide the optimal environment for a safe birth.
Collapse
Affiliation(s)
| | - Ilia Bresesti
- Division of Neonatology, “V. Buzzi” Children’s Hospital, ASST-FBF-Sacco, Milan, Italy
- Division of Pediatrics, “L. Sacco” Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Paolo Tagliabue
- Division of Neonatology, “S. Gerardo” Hospital, MBBM Foundation, Monza, Italy
| | - Maria Grazia Valsecchi
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paola De Lorenzo
- Center of Biostatistics for Clinical Epidemiology and Pediatric Clinic, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Gianluca Lista
- Division of Neonatology, “V. Buzzi” Children’s Hospital, ASST-FBF-Sacco, Milan, Italy
| |
Collapse
|
6
|
Lisanti AJ, Vittner D, Medoff-Cooper B, Fogel J, Wernovsky G, Butler S. Individualized Family-Centered Developmental Care: An Essential Model to Address the Unique Needs of Infants With Congenital Heart Disease. J Cardiovasc Nurs 2020; 34:85-93. [PMID: 30303895 PMCID: PMC6283700 DOI: 10.1097/jcn.0000000000000546] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infants born with critical congenital heart disease (cCHD) who require surgical intervention in the newborn period are often hospitalized in a cardiac intensive care unit (CICU). Cardiac surgery and the CICU environment are traumatic to infants and their families. Infants are exposed to overwhelming stress, which can result in increased pain, physiologic instability, behavioral disorganization, disrupted attachment, and altered brain development. Individualized Family-centered Developmental Care (IFDC) is a model that can address the unique needs and developmental challenges of infants with cCHD. PURPOSE The purpose of this article is to (1) clearly describe the uniqueness of the infant with cCHD, including the medical, neurological, and parental challenges, and (2) propose methods to apply IFDC to support recovery of infants with cCHD in the CICU. CONCLUSIONS The experiences in the CICU shape the developing brain and alter recovery and healing, thus adversely impacting development. Individualized Family-centered Developmental Care is a promising model of care that nurses can integrate into the CICU to promote neuroprotection and development. Nurses can effectively integrate IFDC into the CICU by understanding the unique characteristics of infants with cCHD and applying IFDC interventions that include both maturity and recovery perspectives. CLINICAL IMPLICATIONS The incorporation of IFDC interventions is essential for the infant with cCHD and should be a standard of care. Applying IFDC with a recovery perspective in all aspects of caregiving will provide opportunities for individualization of care and parent engagement, allowing infants in the CICU to recover from surgery while supporting both short- and long-term neurodevelopment.
Collapse
Affiliation(s)
- Amy Jo Lisanti
- Amy Lisanti, PhD, RN, CCNS, CCRN-K NRSA Postdoctoral Fellow, University of Pennsylvania School of Nursing; and Clinical Nurse Specialist/Nurse Scientist, Cardiac Nursing at Children's Hospital of Philadelphia, Pennsylvania. Dorothy Vittner, PhD, RN Nurse Scientist, Connecticut Children's Medical Center, Hartford; and Faculty, School of Nursing and an Assistant Professor, University of Connecticut School of Nursing, Storrs. Barbara Medoff-Cooper, PhD, RN Professor, Univeristy of Pennsylvania School of Nursing, Philadelphia. Jennifer Fogel, M.S.CCC-SLP/L Pediatric Speech Language Pathologist, Advocate Children's Hospital, Oak Lawn, Illinois. Gil Wernovsky, MD Senior Consultant in Cardiac Critical Care and Pediatric Cardiology, Children's National Health System, Washington, District of Columbia. Samantha Butler, PhD Developmental and Clinical Psychologist Director, Boston Children's; and Assistant Professor in Psychiatry, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | |
Collapse
|
7
|
Janssen LC, Van Der Spil J, van Kaam AH, Dieleman JP, Andriessen P, Onland W, Niemarkt HJ. Minimally invasive surfactant therapy failure: risk factors and outcome. Arch Dis Child Fetal Neonatal Ed 2019; 104:F636-F642. [PMID: 31036700 DOI: 10.1136/archdischild-2018-316258] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/20/2019] [Accepted: 02/28/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate incidence of minimally invasive surfactant therapy (MIST) failure, identify risk factors and assess the impact of MIST failure on neonatal outcome. DESIGN Retrospective cohort study. MIST failure was defined as need for early mechanical ventilation (<72 hours of life). Multivariate logistic regression analysis was performed to identify risk factors for MIST failure and compare outcomes between groups. SETTING Two tertiary neonatal intensive care centres in the Netherlands. PATIENTS Infants born between 24 weeks' and 31 weeks' gestational age (GA) (n=185) with MIST for respiratory distress syndrome. INTERVENTIONS MIST procedure with poractant alfa (100-200 mg/kg). MAIN OUTCOME MEASURES Continuous positive airway pressure (CPAP) failure after MIST in the first 72 hours of life. RESULTS 30% of the infants failed CPAP after MIST. In a multivariate logistic regression analysis, four risk factors were independently associated with failure: GA <28 weeks, C reactive protein ≥10 mg/L, absence of antenatal corticosteroids and lower surfactant dose. Infants receiving 200 mg/kg surfactant had a failure rate of 14% versus 35% with surfactant dose <200 mg/kg. Mean body temperature was 0.4°C lower at neonatal intensive care unit admission and before the procedure in infants with MIST failure.Furthermore, MIST failure was independently associated with an increased risk of severe intraventricular haemorrhage. CONCLUSION We observed moderate MIST failure rates in concordance with the results of earlier studies. Absence of corticosteroids and lower surfactant dose are risk factors for MIST failure that may be modifiable in order to improve MIST success and patient outcome.
Collapse
Affiliation(s)
- Lobke Ce Janssen
- Faculty of Medicine, Maastricht University, Maastricht, The Netherlands.,Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Jooske Van Der Spil
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Peter Andriessen
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Wes Onland
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Hendrik J Niemarkt
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
| |
Collapse
|
8
|
May L, Nshimyiryo A, Kubwimana M, Nahimana E, Schoen N, Gadgil A, Kateera F, Feldman HA, Nyishime M, Hansen A. Performance of a Nonelectric Infant Warmer in Rwandan Health Centers. Glob Pediatr Health 2019; 6:2333794X19884820. [PMID: 31696147 PMCID: PMC6820166 DOI: 10.1177/2333794x19884820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/03/2019] [Accepted: 09/13/2019] [Indexed: 01/21/2023] Open
Abstract
Background. Neonatal hypothermia remains a challenge in resource-limited settings. Methods. We conducted a prospective mixed-methods cohort study in rural Rwandan health centers to assess the performance of an infant warmer we designed for low-resource settings. All hypothermic infants were eligible for enrollment. Outcomes. Safety: incidence of adverse reactions. Effectiveness: attainment of euthermia, rate of temperature rise. Feasibility: correct use of warmer, signs of wear. Interviews of caregivers and nurses. Findings. Of 102 encounters, there were no adverse reactions. Of 80 encounters for hypothermia when infants on warmer for ≥1 hour, 79 achieved euthermia; 73 in ≤2 hours. Of the 80 encounters, 64 had temperature rise ≥0.5°C/h. Of the 102 encounters, there were no instances of the warmer being prepared, used, or cleaned incorrectly. Five out of the 12 warmers exhibited wear. Interview participants were predominantly positive; some found time for readiness of warmer challenging. Interpretation. The warmer performed well. It is appropriate to study in larger scale.
Collapse
Affiliation(s)
- Leana May
- Boston Children’s Hospital, MA, USA
- Children’s Hospital of Colorado, Aurora, CO, USA
| | | | | | | | | | - Ashok Gadgil
- Lawrence Berkley National Laboratory, Berkley, CA, USA
| | | | - Henry A. Feldman
- Boston Children’s Hospital, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Anne Hansen
- Boston Children’s Hospital, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
9
|
Duley L, Dorling J, Ayers S, Oliver S, Yoxall CW, Weeks A, Megone C, Oddie S, Gyte G, Chivers Z, Thornton J, Field D, Sawyer A, McGuire W. Improving quality of care and outcome at very preterm birth: the Preterm Birth research programme, including the Cord pilot RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background
Being born very premature (i.e. before 32 weeks’ gestation) has an impact on survival and quality of life. Improving care at birth may improve outcomes and parents’ experiences.
Objectives
To improve the quality of care and outcomes following very preterm birth.
Design
We used mixed methods, including a James Lind Alliance prioritisation, a systematic review, a framework synthesis, a comparative review, qualitative studies, development of a questionnaire tool and a medical device (a neonatal resuscitation trolley), a survey of practice, a randomised trial and a protocol for a prospective meta-analysis using individual participant data.
Setting
For the prioritisation, this included people affected by preterm birth and health-care practitioners in the UK relevant to preterm birth. The qualitative work on preterm birth and the development of the questionnaire involved parents of infants born at three maternity hospitals in southern England. The medical device was developed at Liverpool Women’s Hospital. The survey of practice involved UK neonatal units. The randomised trial was conducted at eight UK tertiary maternity hospitals.
Participants
For prioritisation, 26 organisations and 386 individuals; for the interviews and questionnaire tool, 32 mothers and seven fathers who had a baby born before 32 weeks’ gestation for interviews evaluating the trolley, 30 people who had experienced it being used at the birth of their baby (19 mothers, 10 partners and 1 grandmother) and 20 clinicians who were present when it was being used; for the trial, 261 women expected to have a live birth before 32 weeks’ gestation, and their 276 babies.
Interventions
Providing neonatal care at very preterm birth beside the mother, and with the umbilical cord intact; timing of cord clamping at very preterm birth.
Main outcome measures
Research priorities for preterm birth; feasibility and acceptability of the trolley; feasibility of a randomised trial, death and intraventricular haemorrhage.
Review methods
Systematic review of Cochrane reviews (umbrella review); framework synthesis of ethics aspects of consent, with conceptual framework to inform selection criteria for empirical and analytical studies. The comparative review included studies using a questionnaire to assess satisfaction with care during childbirth, and provided psychometric information.
Results
Our prioritisation identified 104 research topics for preterm birth, with the top 30 ranked. An ethnographic analysis of decision-making during this process suggested ways that it might be improved. Qualitative interviews with parents about their experiences of very preterm birth identified two differences with term births: the importance of the staff appearing calm and of staff taking control. Following a comparative review, this led to the development of a questionnaire to assess parents’ views of care during very preterm birth. A systematic overview summarised evidence for delivery room neonatal care and revealed significant evidence gaps. The framework synthesis explored ethics issues in consent for trials involving sick or preterm infants, concluding that no existing process is ideal and identifying three important gaps. This led to the development of a two-stage consent pathway (oral assent followed by written consent), subsequently evaluated in our randomised trial. Our survey of practice for care at the time of birth showed variation in approaches to cord clamping, and that no hospitals were providing neonatal care with the cord intact. We showed that neonatal care could be provided beside the mother using either the mobile neonatal resuscitation trolley we developed or existing equipment. Qualitative interviews suggested that neonatal care beside the mother is valued by parents and acceptable to clinicians. Our pilot randomised trial compared cord clamping after 2 minutes and initial neonatal care, if needed, with the cord intact, with clamping within 20 seconds and initial neonatal care after clamping. This study demonstrated feasibility of a large UK randomised trial. Of 135 infants allocated to cord clamping ≥ 2 minutes, 7 (5.2%) died and, of 135 allocated to cord clamping ≤ 20 seconds, 15 (11.1%) died (risk difference –5.9%, 95% confidence interval –12.4% to 0.6%). Of live births, 43 out of 134 (32%) allocated to cord clamping ≥ 2 minutes had intraventricular haemorrhage compared with 47 out of 132 (36%) allocated to cord clamping ≤ 20 seconds (risk difference –3.5%, 95% CI –14.9% to 7.8%).
Limitations
Small sample for the qualitative interviews about preterm birth, single-centre evaluation of neonatal care beside the mother, and a pilot trial.
Conclusions
Our programme of research has improved understanding of parent experiences of very preterm birth, and informed clinical guidelines and the research agenda. Our two-stage consent pathway is recommended for intrapartum clinical research trials. Our pilot trial will contribute to the individual participant data meta-analysis, results of which will guide design of future trials.
Future work
Research in preterm birth should take account of the top priorities. Further evaluation of neonatal care beside the mother is merited, and future trial of alternative policies for management of cord clamping should take account of the meta-analysis.
Study registration
This study is registered as PROSPERO CRD42012003038 and CRD42013004405. In addition, Current Controlled Trials ISRCTN21456601.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 8. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Jon Dorling
- Department of Child Health, Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Sandy Oliver
- Social Science Research Unit and EPPI-Centre, Institute of Education, University of London, London, UK
| | | | - Andrew Weeks
- University of Liverpool and Liverpool Women’s Hospital, Members of Liverpool Health Partners, UK
| | - Chris Megone
- Inter Disciplinary Ethics Applied, University of Leeds, Leeds, UK
| | - Sam Oddie
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Gill Gyte
- National Childbirth Trust, London, UK
| | | | - Jim Thornton
- Department of Child Health, Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK
| | - David Field
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, UK
| |
Collapse
|
10
|
O’Brien EA, Colaizy TT, Brumbaugh JE, Cress GA, Johnson KJ, Klein JM, Bell EF. Body temperatures of very low birth weight infants on admission to a neonatal intensive care unit. J Matern Fetal Neonatal Med 2019; 32:2763-2766. [PMID: 29478358 PMCID: PMC6128769 DOI: 10.1080/14767058.2018.1446076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Hypothermia occurs frequently in the first minutes after birth in preterm infants. Hyperthermia also occurs, often as a consequence of efforts to provide thermal support. Both hypothermia and hyperthermia are potentially harmful. Our objective was to examine the distribution of admission temperatures of very low birth weight (VLBW) infants, the effect of gestational age on admission temperatures, and the time required for correction of low temperatures. METHODS Admission axillary temperatures were retrieved from the medical records for all VLBW infants born in our hospital during a 5-year period. The temperatures were classified as severe (<35.0 °C), moderate (35.0-35.9 °C), or mild (36.0-36.4 °C) hypothermia, normothermia (36.5-37.4 °C), or hyperthermia (≥37.5 °C). The relationship between gestational age and admission temperature was examined. In addition, we analyzed the time required for normalization of low temperatures. RESULTS Overall, 12% of infants were severely hypothermic, 40% moderately hypothermic, 27% mildly hypothermic, 19% normothermic, and 2% hyperthermic. Gestational age was inversely related to hypothermia risk and to the time required for recovery to normothermia. CONCLUSION Admission hypothermia is common among VLBW infants and is affected by gestational age.
Collapse
Affiliation(s)
- Emily A. O’Brien
- Physician Assistant Program, Midwestern University, Downers Grove, Illinois, USA
| | - Tarah T. Colaizy
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Jane E. Brumbaugh
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Karen J. Johnson
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | | | - Edward F. Bell
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| |
Collapse
|
11
|
Narayanan I, Nsungwa-Sabiti J, Lusyati S, Rohsiswatmo R, Thomas N, Kamalarathnam CN, Wembabazi JJ, Kirabira VN, Waiswa P, Data S, Kajjo D, Mubiri P, Ochola E, Shrestha P, Choi HY, Ramasethu J. Facility readiness in low and middle-income countries to address care of high risk/ small and sick newborns. Matern Health Neonatol Perinatol 2019; 5:10. [PMID: 31236281 PMCID: PMC6580648 DOI: 10.1186/s40748-019-0105-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 05/14/2019] [Indexed: 11/23/2022] Open
Abstract
Background The successful promotion of facility births in low and middle-income countries has not always resulted in improved neonatal outcome. We evaluated key signal functions pertinent to Level II neonatal care to determine facility readiness to care for high risk/ small and sick newborns. Method Facility readiness for care of high risk/ small and sick babies was determined through self-evaluation using a pre-designed checklist to determine key signal functions pertinent to Level II neonatal care in selected referral hospitals in Uganda (10), Indonesia (4) and India (2) with focus on the Sub-Saharan country with greater challenges. Results Most facilities reported having continuous water supply, resources for hand hygiene and waste disposal. Delivery rooms had newborn corners for basic neonatal resuscitation, but few practiced proper reprocessing of resuscitation equipment. Birth weight records were not consistently maintained in the Ugandan hospitals. In facilities with records of birth weights, more than half (51.7%) of newborns admitted to the neonatal units weighed 2500 g or more. Neonatal mortality rates ranged from 1.5 to 22.5%. Evaluation of stillbirths and numbers of babies discharged against medical advice gave a more comprehensive idea of outcome. Kangaroo Mother Care was practiced to varying extents. Incubators were more common in Africa while radiant warmers were preferred in Indian hospitals. Tube feeding was practiced in all and cup feeding in most, with use of human milk at all sites. There were proportionately more certified pediatricians and nurses in Indonesia and India. There was considerable shortage of nursing staff, (worst nurse –bed ratio ranging from 1 to 15 in the day shift, and 1 to 30 at night). There was significant variability in facility readiness, as in data maintenance, availability of commodities such as linen, air -oxygen blenders and infusion pumps and of infection prevention practices. Conclusions Referral neonatal units in LMIC have challenges in meeting even the basic level II requirements, with significant variability in equipment, staffing and selected care practices. Facility readiness has to improve in concert with increased facility births of high risk newborns in order to have an impact on neonatal outcome, and on achieving Sustainable Development Goals 3.2.2. Electronic supplementary material The online version of this article (10.1186/s40748-019-0105-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Peter Waiswa
- 8Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.,9Global Health Division, Karolinska Institutet, Stockholm, Sweden.,10Leader Makerere University Maternal and Newborn Centre of Excellence, Kampala, Uganda
| | - Santorino Data
- 11Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Darious Kajjo
- 12Makerere University School of Public Health, Kampala, Uganda
| | - Paul Mubiri
- 12Makerere University School of Public Health, Kampala, Uganda
| | - Emmanuel Ochola
- 13Department of HIV, Research and Documentation, St. Mary's Hospital Lacor, Gulu, Uganda
| | | | - Ha Young Choi
- 14MedStar Georgetown University Hospital, Washington, DC, USA
| | | |
Collapse
|
12
|
Bedaso A, Kebede E, Adamu T. Assessment of skin-to-skin contact (SSC) during the postpartum stay and its determinant factors among mothers at public health institutions in Ethiopia. BMC Res Notes 2019; 12:136. [PMID: 30871623 PMCID: PMC6417157 DOI: 10.1186/s13104-019-4176-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/11/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The study aimed at assessing skin-to-skin contact (SSC) during the postpartum stay and its determinant factors among mothers at public health institutions in Ethiopia. RESULT A total of 384 mothers-indexed newborns admitted in postnatal wards were interviewed. The prevalence of mothers' SSC practice to their newborns with in the first 1 h during the postpartum stay was 28.1%. Mothers education (AOR = 18.23 [95% CI 5.26, 63.52]), and number of ANC visits (AOR = 8.55 [95% CI 1.05, 69.54]) were independently associated with SSC practice of mothers to their infants.
Collapse
Affiliation(s)
- Asres Bedaso
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, SNNPR Ethiopia
| | - Emnet Kebede
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, SNNPR Ethiopia
| | - Tariku Adamu
- Department of Midwifery, College of Medicine and Health Science, Assosa University, Assosa, Ethiopia
| |
Collapse
|
13
|
Peleg B, Globus O, Granot M, Leibovitch L, Mazkereth R, Eisen I, Morag I, Stern O, Rozen C, Maayan-Metzger A, Strauss T. "Golden Hour" quality improvement intervention and short-term outcome among preterm infants. J Perinatol 2019; 39:387-392. [PMID: 30341403 DOI: 10.1038/s41372-018-0254-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/22/2018] [Accepted: 10/01/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the impact of a quality improvement intervention during the first hour of life ("Golden Hour") on short-term preterm neonatal outcome. STUDY DESIGN A comprehensive protocol designed for initial stabilization and treatment of preterm infants that included cord blood sampling, use of a dedicated resuscitation room and improved team communication using Crew Resource Management tools. The infants admitted before and after implementation of the protocol were retrospectively compared in a matched case-control design. RESULTS There were 194 infants in the intervention group and 194 controls. Admission temperatures improved significantly from a mean of 35.26 °C to 36.26 °C (P < 0.001), and late-onset sepsis and bronchopulmonary dysplasia rates lowered significantly (P = 0.035 and P = 0.028, respectively) in the intervention group. There was trend towards reduction in early blood transfusion and ventilation duration. CONCLUSIONS A "Golden Hour" quality improvement intervention was of significant benefit for preterm neonates. Further follow-up to assess long-term effects is warranted.
Collapse
Affiliation(s)
- Ben Peleg
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Omer Globus
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Maya Granot
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Leah Leibovitch
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Ram Mazkereth
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Irit Eisen
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Iris Morag
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Orly Stern
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Chava Rozen
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Ayala Maayan-Metzger
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Tzipora Strauss
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel. .,Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
14
|
Nahimana E, May L, Gadgil A, Rapp V, Magge H, Kubwimana M, Nshimyiryo A, Kateera F, Feldman HA, Nkikabahizi F, Sayinzoga F, Hansen A. A low cost, re-usable electricity-free infant warmer: evaluation of safety, effectiveness and feasibiliy. Public Health Action 2018; 8:211-217. [PMID: 30775282 DOI: 10.5588/pha.18.0031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/19/2018] [Indexed: 01/15/2023] Open
Abstract
Setting: Rural Rwandan hospitals, where thermoregulation is critical yet a challenge for pre-term, low-birth-weight (LBW) or sick newborns. Objective: To assess the safety, effectiveness, and feasibility of an inexpensive, reusable, non-electric warmer to complement kangaroo mother care (KMC). Methods: Prospective single-arm, non-randomized intervention study. Enrolled infants were hypothermic or at risk of hypothermia due to prematurity/LBW. Infants used the warmer in conjunction with KMC or as the sole source of external heat. Temperatures of the infant, warmer and air were measured for up to 6 h. Results: Overall, 33 patients used the warmer for 102 encounters: 43 hypothermic and 59 at risk of hypothermia. In 7/102 encounters (7%), the infant developed a temperature of >37.5°C (37.6°-38.2°C). For 43 hypothermic encounters and 59 at-risk encounters, hypothermia was corrected/prevented in respectively 41 (95%) and 59 (100%) instances. The warmer maintained goal temperature for the study duration in ⩾85% of uses. Two/12 warmers broke down after <10 uses. In no instances was the warmer used incorrectly. Conclusion: Our results are promising for this prototype design, and warrant testing on a wider scale.
Collapse
Affiliation(s)
- E Nahimana
- Partners In Health, Inshuti Mu Buzima, Kigali, Rwanda
| | - L May
- Boston Children's Hospital, Boston, Massachusetts, USA.,Children's Hospital of Colorado, Aurora, Colorado, USA
| | - A Gadgil
- Lawrence Berkeley National Laboratory, Berkeley, California, USA.,University of California, Berkeley, California, USA
| | - V Rapp
- Lawrence Berkeley National Laboratory, Berkeley, California, USA
| | - H Magge
- Partners In Health, Inshuti Mu Buzima, Kigali, Rwanda.,Boston Children's Hospital, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - M Kubwimana
- Partners In Health, Inshuti Mu Buzima, Kigali, Rwanda
| | - A Nshimyiryo
- Partners In Health, Inshuti Mu Buzima, Kigali, Rwanda
| | - F Kateera
- Partners In Health, Inshuti Mu Buzima, Kigali, Rwanda
| | - H A Feldman
- Boston Children's Hospital, Boston, Massachusetts, USA.,Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - F Nkikabahizi
- Rwinkwavu District Hospital, Rwanda Ministry of Health, Kayonza, Rwanda
| | | | - A Hansen
- Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
15
|
Acharya Y. Effects of a community-based neonatal care package program. Health Policy Plan 2018; 33:592-601. [PMID: 29562262 DOI: 10.1093/heapol/czy021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 11/13/2022] Open
Abstract
This article evaluates a community-based effort aimed at reducing neonatal mortality. I use nationally representative data from Nepal, where 22 children per 1000 die within the first month of their birth, and evaluate the impact of Community-Based Neonatal Care Package. The identification is based on a before-and-after comparison of outcomes in program districts relative to those in non-program districts. I find that the program was successful in encouraging cleaner deliveries for births that took place at home and in increasing prenatal visits to the health center by pregnant women significantly. Despite these positive effects on intermediate outcomes, there is no evidence that the program reduced neonatal mortality. There is also no evidence that the program improved other intermediate outcomes, namely institutional or professional-attended deliveries. While the lack of an effect on a few of the outcomes may be mainly due to supply-side constraints, the findings also suggest the need for a broader examination of the role of the Female Community Health Volunteers.
Collapse
Affiliation(s)
- Yubraj Acharya
- Department of Health Policy and Administration, College of Health and Human Development, Pennsylvania State University, 601L Ford Building, University Park, PA 16802, USA
| |
Collapse
|
16
|
Knol R, Brouwer E, Vernooij ASN, Klumper FJCM, DeKoninck P, Hooper SB, te Pas AB. Clinical aspects of incorporating cord clamping into stabilisation of preterm infants. Arch Dis Child Fetal Neonatal Ed 2018; 103:F493-F497. [PMID: 29680790 PMCID: PMC6109247 DOI: 10.1136/archdischild-2018-314947] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 12/30/2022]
Abstract
Fetal to neonatal transition is characterised by major pulmonary and haemodynamic changes occurring in a short period of time. In the international neonatal resuscitation guidelines, comprehensive recommendations are available on supporting pulmonary transition and delaying clamping of the cord in preterm infants. Recent experimental studies demonstrated that the pulmonary and haemodynamic transition are intimately linked, could influence each other and that the timing of umbilical cord clamping should be incorporated into the respiratory stabilisation. We reviewed the current knowledge on how to incorporate cord clamping into stabilisation of preterm infants and the physiological-based cord clamping (PBCC) approach, with the infant's transitional status as key determinant of timing of cord clamping. This approach could result in optimal timing of cord clamping and has the potential to reduce major morbidities and mortality in preterm infants.
Collapse
Affiliation(s)
- Ronny Knol
- Division of Neonatology, Department of Paediatrics, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Emma Brouwer
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Alex S N Vernooij
- Department of Medical Engineering, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frans J C M Klumper
- Department of Obstetrics, Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
| | - Philip DeKoninck
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands,The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia
| | - Arjan B te Pas
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
17
|
Choi HS, Lee SM, Eun H, Park M, Park KI, Namgung R. The impact of a quality improvement effort in reducing admission hypothermia in preterm infants following delivery. KOREAN JOURNAL OF PEDIATRICS 2018; 61:239-244. [PMID: 30130949 PMCID: PMC6107400 DOI: 10.3345/kjp.2018.61.8.239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/01/2017] [Accepted: 11/08/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE Hypothermia at admission is associated with increased mortality and morbidity in preterm infants. We performed a quality improvement (QI) effort to determine the impact of a decrease in admission hypothermia in preterm infants. METHODS The study enrolled very low birth weight (VLBW) infants born at Gangnam Severance Hospital between January 2013 and December 2016. This multidisciplinary QI effort included the use of occlusive wraps, warm blankets, and caps; the delivery room temperature was maintained above 23.0˚C, and a check-list was used for feedback. RESULTS Among 259 preterm infants, the incidence of hypothermia (defined as body temperature <36.0˚C) decreased significantly from 68% to 41%, and the mean body temperature on neonatal intensive care unit admission increased significantly from 35.5˚C to 36.0˚C. In subgroup analysis of VLBW infants, admission hypothermia and neonatal outcomes were compared between the pre-QI (n=55) and post-QI groups (n=75). Body temperature on admission increased significantly from 35.4˚C to 35.9˚C and the number of infants with hypothermia decreased significantly from 71% to 45%. There were no cases of neonatal hyperthermia. The incidence of pulmonary hemorrhage was significantly decreased (P=0.017). Interaction analysis showed that birth weight and gestational age were not correlated with hypothermia following implementation of the protocol. CONCLUSION Our study demonstrated a significant reduction in admission hypothermia following the introduction of a standardized protocol in our QI effort. This resulted in an effective reduction in the incidence of massive pulmonary hemorrhage.
Collapse
Affiliation(s)
- Han Saem Choi
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Hoseon Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Minsoo Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Kook-In Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ran Namgung
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
18
|
Shah V, Hodgson K, Seshia M, Dunn M, Schmölzer GM. Golden hour management practices for infants <32 weeks gestational age in Canada. Paediatr Child Health 2018; 23:e70-e76. [PMID: 30038535 PMCID: PMC6007305 DOI: 10.1093/pch/pxx175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine 'Golden Hour' resuscitation and stabilization practices for infants <32 weeks gestational age in Canadian neonatal intensive care units (NICUs). METHODS A survey was distributed to investigators of the Evidence-based Practice for Improving Quality study within the Canadian Neonatal Network in June 2014. The questionnaire was designed to obtain information on antenatal counselling, resuscitation environment, resuscitation and management practices, including respiratory and nutritional practices in the first hour of life. Responses to these categories were stratified into gestational age groupings: 230/7-236/7, 240/7-256/7, 260/7-276/7 and 280/7-316/7 weeks. Findings were summarized using descriptive statistics. RESULTS Investigators from 14 of the 23 (61%) NICUs responded. Antenatal counselling was provided to >75% of expectant parents by Staff Neonatologists and Neonatal Fellows. Most NICUs (78%) provided resuscitation in a room adjacent to the high-risk delivery room or the NICU, while few (36%) resuscitated in the delivery room only. Twelve (86%) NICUs practiced delayed cord clamping while two practiced milking of the cord (14%) and 100% used thermal wrap for infants <28 weeks' gestation. All, with the exception of three NICUs used fraction of inspired oxygen ≤0.3 for initial resuscitation and 12/14 (86%) centres applied continuous positive airway pressure for spontaneously breathing infants <256/7 weeks' gestation. CONCLUSIONS Participating Canadian NICUs reported that they generally follow Neonatal Resuscitation Program recommendations for stabilization of preterm infants; however, considerable variation exists in the application of evidence-based interventions. Our findings can be used to inform quality improvement initiatives to improve clinical outcomes for this vulnerable population.
Collapse
Affiliation(s)
- Vibhuti Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario
- Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Kate Hodgson
- Department of Paediatrics, University of Toronto, Toronto, Ontario
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario
| | - Mary Seshia
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba
| | - Michael Dunn
- Department of Paediatrics, University of Toronto, Toronto, Ontario
- Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| |
Collapse
|
19
|
Saaka M, Ali F, Vuu F. Prevalence and determinants of essential newborn care practices in the Lawra District of Ghana. BMC Pediatr 2018; 18:173. [PMID: 29793543 PMCID: PMC5968597 DOI: 10.1186/s12887-018-1145-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 05/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There was less than satisfactory progress, especially in sub-Saharan Africa, towards child and maternal mortality targets of Millennium Development Goals (MDGs) 4 and 5. The main aim of this study was to describe the prevalence and determinants of essential new newborn care practices in the Lawra District of Ghana. METHODS A cross-sectional study was carried out in June 2014 on a sample of 422 lactating mothers and their children aged between 1 and 12 months. A systematic random sampling technique was used to select the study participants who attended post-natal clinic in the Lawra district hospital. RESULTS Of the 418 newborns, only 36.8% (154) was judged to have had safe cord care, 34.9% (146) optimal thermal care, and 73.7% (308) were considered to have had adequate neonatal feeding. The overall prevalence of adequate new born care comprising good cord care, optimal thermal care and good neonatal feeding practices was only 15.8%. Mothers who attained at least Senior High Secondary School were 20.5 times more likely to provide optimal thermal care [AOR 22.54; 95% CI (2.60-162.12)], compared to women had no formal education at all. Women who received adequate ANC services were 4.0 times (AOR = 4.04 [CI: 1.53, 10.66]) and 1.9 times (AOR = 1.90 [CI: 1.01, 3.61]) more likely to provide safe cord care and good neonatal feeding as compared to their counterparts who did not get adequate ANC. However, adequate ANC services was unrelated to optimal thermal care. Compared to women who delivered at home, women who delivered their index baby in a health facility were 5.6 times more likely of having safe cord care for their babies (AOR = 5.60, Cl: 1.19-23.30), p = 0.03. CONCLUSIONS The coverage of essential newborn care practices was generally low. Essential newborn care practices were positively associated with high maternal educational attainment, adequate utilization of antenatal care services and high maternal knowledge of newborn danger signs. Therefore, greater improvement in essential newborn care practices could be attained through proven low-cost interventions such as effective ANC services, health and nutrition education that should span from community to health facility levels.
Collapse
Affiliation(s)
- Mahama Saaka
- University for Development Studies, School of Allied Health Sciences, P O Box, 1883 Tamale, Ghana
| | - Fusena Ali
- University for Development Studies, School of Allied Health Sciences, P O Box, 1883 Tamale, Ghana
| | - Felicia Vuu
- University for Development Studies, School of Allied Health Sciences, P O Box, 1883 Tamale, Ghana
| |
Collapse
|
20
|
Hu XJ, Wang L, Zheng RY, Lv TC, Zhang YX, Cao Y, Huang GY. Using polyethylene plastic bag to prevent moderate hypothermia during transport in very low birth weight infants: a randomized trial. J Perinatol 2018; 38:332-336. [PMID: 29282354 DOI: 10.1038/s41372-017-0028-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 08/29/2017] [Accepted: 09/21/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Hypothermia remains a significant problem among very low birth weight (VLBW) infants. The use of occlusive polyethylene plastic bags immediately after birth has been proven to be effective for preterm infants to reduce hypothermia. This study aims to determine whether placing VLBW infants in plastic bags during transport reduces hypothermia. STUDY DESIGN Study infants were randomly assigned to a standard thermoregulation protocol or to a standard thermoregulation protocol with placement of the torso and lower extremities inside a polyethylene plastic bag during transport. The primary outcome measures were axillary temperature before and after transport and the occurrence of moderate hypothermia upon neonatal intensive care unit admission. RESULT The 108 VLBW infants recruited into the study were randomized to the plastic bag (n = 54) group or to standard group (n = 54) and had similar baseline characteristics. VLBW infants in the plastic bag group had a lower rate of moderate hypothermia (3.7 vs 27.8%; risk ratio 0.10; confidence interval 0.02-0.46; P < 0.001) and higher axillary temperatures (36.4 ± 0.4 °C vs 35.9 ± 0.9 °C; P = 0.001) upon NICU admission compared to infants receiving standard care. CONCLUSION Placing VLBW infants in polyethylene plastic bags during transport reduces the occurrence of hypothermia, especially moderate hypothermia.
Collapse
Affiliation(s)
- Xiao-Jing Hu
- Neonatal Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Li Wang
- Neonatal Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Ru-Yi Zheng
- Neonatal Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Tian-Chan Lv
- Neonatal Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Yu-Xia Zhang
- Neonatal Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Yun Cao
- Neonatal Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Guo-Ying Huang
- Neonatal Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China. .,Shanghai Key Laboratory of Birth Defects, Shanghai, China.
| |
Collapse
|
21
|
Carns J, Kawaza K, Quinn MK, Miao Y, Guerra R, Molyneux E, Oden M, Richards-Kortum R. Impact of hypothermia on implementation of CPAP for neonatal respiratory distress syndrome in a low-resource setting. PLoS One 2018; 13:e0194144. [PMID: 29543861 PMCID: PMC5854332 DOI: 10.1371/journal.pone.0194144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/26/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Neonatal hypothermia is widely associated with increased risks of morbidity and mortality, but remains a pervasive global problem. No studies have examined the impact of hypothermia on outcomes for preterm infants treated with CPAP for respiratory distress syndrome (RDS). METHODS This retrospective analysis assessed the impact of hypothermia on outcomes of 65 neonates diagnosed with RDS and treated with either nasal oxygen (N = 17) or CPAP (N = 48) in a low-resource setting. A classification tree approach was used to develop a model predicting survival for subjects diagnosed with RDS. FINDINGS Survival to discharge was accurately predicted based on three variables: mean temperature, treatment modality, and mean respiratory rate. None of the 23 neonates with a mean temperature during treatment below 35.8°C survived to discharge, regardless of treatment modality. Among neonates with a mean temperature exceeding 35.8°C, the survival rate was 100% for the 31 neonates treated with CPAP and 36.4% for the 11 neonates treated with nasal oxygen (p<0.001). For neonates treated with CPAP, outcomes were poor if more than 50% of measured temperatures indicated hypothermia (5.6% survival). In contrast, all 30 neonates treated with CPAP and with more than 50% of temperature measurements above 35.8°C survived to discharge, regardless of initial temperature. CONCLUSION The results of our study suggest that successful implementation of CPAP to treat RDS in low-resource settings will require aggressive action to prevent persistent hypothermia. However, our results show that even babies who are initially cold can do well on CPAP with proper management of hypothermia.
Collapse
Affiliation(s)
- Jennifer Carns
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
| | - Kondwani Kawaza
- Department of Pediatrics, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - MK Quinn
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
| | - Yinsen Miao
- Department of Statistics, Rice University, Houston, Texas, United States of America
| | - Rudy Guerra
- Department of Statistics, Rice University, Houston, Texas, United States of America
| | - Elizabeth Molyneux
- Department of Pediatrics, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Maria Oden
- Department of Bioengineering, Rice University, Houston, Texas, United States of America
| | | |
Collapse
|
22
|
McCall EM, Alderdice F, Halliday HL, Vohra S, Johnston L. Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants. Cochrane Database Syst Rev 2018; 2:CD004210. [PMID: 29431872 PMCID: PMC6491068 DOI: 10.1002/14651858.cd004210.pub5] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Newborn admission temperature is a strong predictor of outcomes across all gestations. Hypothermia immediately after birth remains a worldwide issue and, if prolonged, is associated with harm. Keeping preterm infants warm is difficult even when recommended routine thermal care guidelines are followed in the delivery room. OBJECTIVES To assess the efficacy and safety of interventions designed for prevention of hypothermia in preterm and/or low birth weight infants applied within 10 minutes after birth in the delivery room, compared with routine thermal care or any other single/combination of intervention(s) also designed for prevention of hypothermia in preterm and/or low birth weight infants applied within 10 minutes after birth in the delivery room. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 5), MEDLINE via PubMed (1966 to 30 June 2016), Embase (1980 to 30 June 2016), and CINAHL (1982 to 30 June 2016). We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Trials using randomised or quasi-randomised allocations to test interventions designed to prevent hypothermia (apart from 'routine' thermal care) applied within 10 minutes after birth in the delivery room for infants at < 37 weeks' gestation and/or birth weight ≤ 2500 grams. DATA COLLECTION AND ANALYSIS We used Cochrane Neonatal methods when performing data collection and analysis. MAIN RESULTS Twenty-five studies across 15 comparison groups met the inclusion criteria, categorised as: barriers to heat loss (18 studies); external heat sources (three studies); and combinations of interventions (four studies).Barriers to heat loss Plastic wrap or bag versus routine carePlastic wraps improved core body temperature on admission to the neonatal intensive care unit (NICU) or up to two hours after birth (mean difference (MD) 0.58°C, 95% confidence interval (CI) 0.50 to 0.66; 13 studies; 1633 infants), and fewer infants had hypothermia on admission to the NICU or up to two hours after birth (typical risk ratio (RR) 0.67, 95% CI 0.62 to 0.72; typical risk reduction (RD) -0.25, 95% CI -0.29 to -0.20; number needed to treat for an additional beneficial outcome (NNTB) 4, 95% CI 4 to 5; 10 studies; 1417 infants). Risk of hyperthermia on admission to the NICU or up to two hours after birth was increased in infants in the wrapped group (typical RR 3.91, 95% CI 2.05 to 7.44; typical RD 0.04, 95% CI 0.02 to 0.06; number needed to treat for an additional harmful outcome (NNTH) 25, 95% CI 17 to 50; 12 studies; 1523 infants), but overall, fewer infants receiving plastic wrap were outside the normothermic range (typical RR 0.75, 95% CI 0.69 to 0.81; typical RD -0.20, 95% CI -0.26 to -0.15; NNTH 5, 95% CI 4 to 7; five studies; 1048 infants).Evidence was insufficient to suggest that plastic wraps or bags significantly reduce risk of death during hospital stay or other major morbidities, with the exception of reducing risk of pulmonary haemorrhage.Evidence of practices regarding permutations on this general approach is still emerging and has been based on the findings of only one or two small studies.External heat sourcesEvidence is emerging on the efficacy of external heat sources, including skin-to-skin care (SSC) versus routine care (one study; 31 infants) and thermal mattress versus routine care (two studies; 126 infants).SSC was shown to be effective in reducing risk of hypothermia when compared with conventional incubator care for infants with birth weight ≥ 1200 and ≤ 2199 grams (RR 0.09, 95% CI 0.01 to 0.64; RD -0.56, 95% CI -0.84 to -0.27; NNTB 2, 95% CI 1 to 4). Thermal (transwarmer) mattress significantly kept infants ≤ 1500 grams warmer (MD 0.65°C, 95% CI 0.36 to 0.94) and reduced the incidence of hypothermia on admission to the NICU, with no significant difference in hyperthermia risk.Combinations of interventionsTwo studies (77 infants) compared thermal mattresses versus plastic wraps or bags for infants at ≤ 28 weeks' gestation. Investigators reported no significant differences in core body temperature nor in the incidence of hypothermia, hyperthermia, or core body temperature outside the normothermic range on admission to the NICU.Two additional studies (119 infants) compared plastic bags and thermal mattresses versus plastic bags alone for infants at < 31 weeks' gestation. Meta-analysis of these two studies showed improvement in core body temperature on admission to the NICU or up to two hours after birth, but an increase in hyperthermia. Data show no significant difference in the risk of having a core body temperature outside the normothermic range on admission to the NICU nor in the risk of other reported morbidities. AUTHORS' CONCLUSIONS Evidence of moderate quality shows that use of plastic wraps or bags compared with routine care led to higher temperatures on admission to NICUs with less hypothermia, particularly for extremely preterm infants. Thermal mattresses and SSC also reduced hypothermia risk when compared with routine care, but findings are based on two or fewer small studies. Caution must be taken to avoid iatrogenic hyperthermia, particularly when multiple interventions are used simultaneously. Limited evidence suggests benefit and no evidence of harm for most short-term morbidity outcomes known to be associated with hypothermia, including major brain injury, bronchopulmonary dysplasia, retinopathy of prematurity, necrotising enterocolitis, and nosocomial infection. Many observational studies have shown increased mortality among preterm hypothermic infants compared with those who maintain normothermia, yet evidence is insufficient to suggest that these interventions reduce risk of in-hospital mortality across all comparison groups. Hypothermia may be a marker for illness and poorer outcomes by association rather than by causality. Limitations of this review include small numbers of identified studies; small sample sizes; and variations in methods and definitions used for hypothermia, hyperthermia, normothermia, routine care, and morbidity, along with lack of power to detect effects on morbidity and mortality across most comparison groups. Future studies should: be adequately powered to detect rarer outcomes; apply standardised morbidity definitions; focus on longer-term outcomes, particularly neurodevelopmental outcomes.
Collapse
Affiliation(s)
- Emma M McCall
- Queen's University BelfastSchool of Nursing and MidwiferyMedical Biology Centre97 Lisburn RoadBelfastNorthern IrelandUK
| | - Fiona Alderdice
- Nuffield Department of Population Health, University of OxfordNational Perinatal Epidemiology UnitOxfordUK
| | - Henry L Halliday
- Retired Honorary Professor of Child Health, Queen's University Belfast74 Deramore Park SouthBelfastNorthern IrelandUKBT9 5JY
| | - Sunita Vohra
- University of AlbertaDepartment of Pediatrics8B19 11111 Jasper AvenueEdmontonABCanadaT5K 0L4
| | - Linda Johnston
- University of TorontoLawrence S Bloomberg Faculty of NursingHealth Sciences Building155 College StreetTorontoOntarioCanadaM5T 2S8
- Soochow UniversityTaipeiTaiwan
- The University of MelbourneMelbourneAustralia
| | | |
Collapse
|
23
|
Abstract
"Golden Hour" of neonatal life is defined as the first hour of post-natal life in both preterm and term neonates. This concept in neonatology has been adopted from adult trauma where the initial first hour of trauma management is considered as golden hour. The "Golden hour" concept includes practicing all the evidence based intervention for term and preterm neonates, in the initial sixty minutes of postnatal life for better long-term outcome. Although the current evidence supports the concept of golden hour in preterm and still there is no evidence seeking the benefit of golden hour approach in term neonates, but neonatologist around the globe feel the importance of golden hour concept equally in both preterm and term neonates. Initial first hour of neonatal life includes neonatal resuscitation, post-resuscitation care, transportation of sick newborn to neonatal intensive care unit, respiratory and cardiovascular support and initial course in nursery. The studies that evaluated the concept of golden hour in preterm neonates showed marked reduction in hypothermia, hypoglycemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). In this review article, we will discuss various components of neonatal care that are included in "Golden hour" of preterm and term neonatal care.
Collapse
Affiliation(s)
- Deepak Sharma
- National Institute of Medical Science, Jaipur, Rajasthan India
| |
Collapse
|
24
|
Nosherwan A, Cheung PY, Schmölzer GM. Management of Extremely Low Birth Weight Infants in Delivery Room. Clin Perinatol 2017; 44:361-375. [PMID: 28477666 DOI: 10.1016/j.clp.2017.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Extremely low birth weight (ELBW) infants are particularly vulnerable at birth, and stabilization in the delivery room (DR) remains challenging. After birth, ELBW infants are at high risk for the development of thermal dysregulation, respiratory insufficiency, and hemodynamic instability due to their immature physiology and anatomy. Although successful stabilization facilitates the transition and reduces acute morbidity, suboptimal care in the DR could cause long-term sequelae. This review addresses the challenges in stabilization in the DR and current neonatal resuscitation guidelines and recommendations.
Collapse
Affiliation(s)
- Asma Nosherwan
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, 10240 Kingsway Avenue Northwest, Edmonton, Alberta T5H 3V9, Canada; Department of Pediatrics, University of Alberta, 116 St & 85 Avenue, Edmonton, Alberta T6G 2R3, Canada
| | - Po-Yin Cheung
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, 10240 Kingsway Avenue Northwest, Edmonton, Alberta T5H 3V9, Canada; Department of Pediatrics, University of Alberta, 116 St & 85 Avenue, Edmonton, Alberta T6G 2R3, Canada
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, 10240 Kingsway Avenue Northwest, Edmonton, Alberta T5H 3V9, Canada; Department of Pediatrics, University of Alberta, 116 St & 85 Avenue, Edmonton, Alberta T6G 2R3, Canada.
| |
Collapse
|
25
|
Manley BJ, Owen LS, Hooper SB, Jacobs SE, Cheong JLY, Doyle LW, Davis PG. Towards evidence-based resuscitation of the newborn infant. Lancet 2017; 389:1639-1648. [PMID: 28443558 DOI: 10.1016/s0140-6736(17)30547-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 11/23/2016] [Accepted: 11/25/2016] [Indexed: 01/07/2023]
Abstract
Effective resuscitation of the newborn infant has the potential to save many lives around the world and reduce disabilities in children who survive peripartum asphyxia. In this Series paper, we highlight some of the important advances in the understanding of how best to resuscitate newborn infants, which includes monitoring techniques to guide resuscitative efforts, increasing awareness of the adverse effects of hyperoxia, delayed umbilical cord clamping, the avoidance of routine endotracheal intubation for extremely preterm infants, and therapeutic hypothermia for hypoxic-ischaemic encephalopathy. Despite the challenges of performing high-quality clinical research in the delivery room, researchers continue to refine and advance our knowledge of effective resuscitation of newborn infants through scientific experiments and clinical trials.
Collapse
Affiliation(s)
- Brett J Manley
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia.
| | - Louise S Owen
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute for Medical Research, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC Australia
| | - Susan E Jacobs
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Jeanie L Y Cheong
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Lex W Doyle
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Peter G Davis
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| |
Collapse
|
26
|
Abstract
"Golden 60 minutes "or "Golden Hour" is defined as the first hour of the newborn after birth. This hour includes resuscitation care, transport to nursery from place of birth and course in nursery. The concept of "Golden hour" includes evidence based interventions that are done in the first 60 min of postnatal life for the better long term outcome of the preterm newborn especially extreme premature, extreme low birth weight and very low birth weight. The evidence shows that the concept of "Golden 60 minutes" leads to reduction in neonatal complications like hypothermia, hypoglycemia, intraventricular hemorrhage, chronic lung disease and retinopathy of prematurity. In this review, we have covered various interventions included in "Golden hour" for preterm newborn namely delayed cord clamping, prevention of hypothermia, respiratory and cardiovascular system support, prevention of sepsis, nutritional support and communication with family.
Collapse
|
27
|
Mank A, van Zanten HA, Meyer MP, Pauws S, Lopriore E, te Pas AB. Hypothermia in Preterm Infants in the First Hours after Birth: Occurrence, Course and Risk Factors. PLoS One 2016; 11:e0164817. [PMID: 27812148 PMCID: PMC5094660 DOI: 10.1371/journal.pone.0164817] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 10/01/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hypothermia is associated with increased morbidity and mortality rates. Preterm infants frequently have hypothermia when they are admitted to the NICU, but there is no data on the occurrence of hypothermia during the first hours after admission. OBJECTIVE To investigate the occurrence of hypothermia in preterm infants in the first three hours of admission and to identify risk factors. METHODS Infants < 32 weeks of gestation included in a randomized trial with admission temperature as primary outcome were retrospectively analyzed for the occurrence of hypothermia (< 36.5°C) in the first three hours after admission. Risk factors were identified using linear regression analysis and logistic regression. RESULTS In total 80 infants were included with a median (IQR) gestational age at birth of 29 (27-30) weeks. In 93% of the infants hypothermia occurred in the first three hours after admission. The median (IQR) duration of hypothermia was 101 (34-162) minutes, of which 24 (7-52) minutes the hypothermia was mild, 45 (4-111) minutes moderate, severe hypothermia hardly occurred. Gestational age and the occurrence of hypothermia at birth were independent risk factors for the occurrence of moderate and severe hypothermia and significantly correlated with duration of hypothermia. CONCLUSIONS Hypothermia occurred often and for a long period in preterm infants in the first three hours of life, low gestational age and admission temperature were independent risk factors.
Collapse
Affiliation(s)
- Arenda Mank
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Henriëtte A. van Zanten
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Michael P. Meyer
- Division of Neonatology, Department of Pediatrics, Middlemore Hospital, Auckland, New Zealand
| | - Steffen Pauws
- Philips Research - Healthcare, Eindhoven, The Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Arjan B. te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
28
|
Trevisanuto D, Cavallin F, Arnolda G, Chien TD, Lincetto O, Xuan NM, Tien NV, Hoi NTX, Moccia L. Equipment for neonatal resuscitation in a middle-income country: a national survey in Vietnam. BMC Pediatr 2016; 16:139. [PMID: 27544219 PMCID: PMC4992562 DOI: 10.1186/s12887-016-0664-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions to improve neonatal resuscitation are considered a priority for reducing neonatal mortality. In addition to training programs for health caregivers, the availability of adequate equipment in all delivery settings is crucial. In this study, we assessed the availability of equipment for neonatal resuscitation in a large sample of delivery rooms in Vietnam, exploring regional differences. METHODS In 2012, a structured questionnaire on 2011 neonatal resuscitation practice was sent to the heads of 187 health facilities, representing the three levels of hospital-based maternity services in eight administrative regions in Vietnam, allowing national and regional estimates to be calculated. RESULTS Overall the response rate was an 85.7 % (160/187 hospitals). There was a limited availability of equipment considered as "essential" in the surveyed centres: stethoscopes (68.0 %; 95 % CI: 60.3-75.7), clock (50.3 %; 42.0-58.7), clothes (29.5 %; (22.0-36.9), head covering (12.3 %; 7.2-17.4). The percentage of centres equipped with polyethylene bags (2.2 %; 0.0-4.6), pulse oximeter (9.4 %; 5.2-13.6) and room air source (1.9 %; 0.1-3.6) was very low. CONCLUSION Adequate equipment for neonatal resuscitation was not available in a considerable proportion of hospitals in Vietnam. This problem was more relevant in some regions. The assessment strategy used in this study could be useful for organizing the procurement and distribution of supplies and equipment in other low and/or middle resource settings.
Collapse
Affiliation(s)
- Daniele Trevisanuto
- Women's and Children's Health Department, Medical School, University of Padua, Azienda Ospedaliera di Padova, Via Giustiniani, 3, 35128, Padua, Italy.
- Amici della Neonatologia Trentina (ANT), Trento, Italy.
| | | | - Gaston Arnolda
- Thrive Networks, Oakland, CA, USA
- School of Public Health & Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Ornella Lincetto
- World Health Organization, Country Office Bhutan, Thimphu, Bhutan
| | - Ngo Minh Xuan
- University of Medicine Pham Ngoc Thach, Ho Chi Minh City, Vietnam
- Perinatal and Neonatal Association of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | | | - Luciano Moccia
- Amici della Neonatologia Trentina (ANT), Trento, Italy
- Thrive Networks, Oakland, CA, USA
| |
Collapse
|
29
|
Hodgins S, Tielsch J, Rankin K, Robinson A, Kearns A, Caglia J. A New Look at Care in Pregnancy: Simple, Effective Interventions for Neglected Populations. PLoS One 2016; 11:e0160562. [PMID: 27537281 PMCID: PMC4990268 DOI: 10.1371/journal.pone.0160562] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Although this is beginning to change, the content of antenatal care has been relatively neglected in safe-motherhood program efforts. This appears in part to be due to an unwarranted belief that interventions over this period have far less impact than those provided around the time of birth. In this par, we review available evidence for 21 interventions potentially deliverable during pregnancy at high coverage to neglected populations in low income countries, with regard to effectiveness in reducing risk of: maternal mortality, newborn mortality, stillbirth, prematurity and intrauterine growth restriction. Selection was restricted to interventions that can be provided by non-professional health auxiliaries and not requiring laboratory support. METHODS In this narrative review, we included relevant Cochrane and other systematic reviews and did comprehensive bibliographic searches. Inclusion criteria varied by intervention; where available randomized controlled trial evidence was insufficient, observational study evidence was considered. For each intervention we focused on overall contribution to our outcomes of interest, across varying epidemiologies. RESULTS In the aggregate, achieving high effective coverage for this set of interventions would very substantially reduce risk for our outcomes of interest and reduce outcome inequities. Certain specific interventions, if pushed to high coverage have significant potential impact across many settings. For example, reliable detection of pre-eclampsia followed by timely delivery could prevent up to ¼ of newborn and stillbirth deaths and over 90% of maternal eclampsia/pre-eclampsia deaths. Other interventions have potent effects in specific settings: in areas of high P falciparum burden, systematic use of insecticide-treated nets and/or intermittent presumptive therapy in pregnancy could reduce maternal mortality by up to 10%, newborn mortality by up to 20%, and stillbirths by up to 25-30%. Behavioral interventions targeting practices at birth and in the hours that follow can have substantial impact in settings where many births happen at home: in such circumstances early initiation of breastfeeding can reduce risk of newborn death by up to 20%; good thermal care practices can reduce mortality risk by a similar order of magnitude. CONCLUSIONS Simple interventions delivered during pregnancy have considerable potential impact on important mortality outcomes. More programmatic effort is warranted to ensure high effective coverage.
Collapse
Affiliation(s)
- Stephen Hodgins
- Saving Newborn Lives, Save the Children/ US, Washington, D.C., United States of America
| | - James Tielsch
- Milken Institute School of Public Health, George Washington University, Washington, D.C., United States of America
| | - Kristen Rankin
- Saving Newborn Lives, Save the Children/ US, Washington, D.C., United States of America
| | - Amber Robinson
- Department of Life Sciences, Brunel University London, London, United Kingdom
| | - Annie Kearns
- Human Care Systems, Boston, Massachusetts, United States of America
| | - Jacquelyn Caglia
- T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| |
Collapse
|
30
|
Zeitlin J, Manktelow BN, Piedvache A, Cuttini M, Boyle E, van Heijst A, Gadzinowski J, Van Reempts P, Huusom L, Weber T, Schmidt S, Barros H, Dillalo D, Toome L, Norman M, Blondel B, Bonet M, Draper ES, Maier RF. Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort. BMJ 2016; 354:i2976. [PMID: 27381936 PMCID: PMC4933797 DOI: 10.1136/bmj.i2976] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To evaluate the implementation of four high evidence practices for the care of very preterm infants to assess their use and impact in routine clinical practice and whether they constitute a driver for reducing mortality and neonatal morbidity. DESIGN Prospective multinational population based observational study. SETTING 19 regions from 11 European countries covering 850 000 annual births participating in the EPICE (Effective Perinatal Intensive Care in Europe for very preterm births) project. PARTICIPANTS 7336 infants born between 24+0 and 31+6 weeks' gestation in 2011/12 without serious congenital anomalies and surviving to neonatal admission. MAIN OUTCOME MEASURES Combined use of four evidence based practices for infants born before 28 weeks' gestation using an "all or none" approach: delivery in a maternity unit with appropriate level of neonatal care; administration of antenatal corticosteroids; prevention of hypothermia (temperature on admission to neonatal unit ≥36°C); surfactant used within two hours of birth or early nasal continuous positive airway pressure. Infant outcomes were in-hospital mortality, severe neonatal morbidity at discharge, and a composite measure of death or severe morbidity, or both. We modelled associations using risk ratios, with propensity score weighting to account for potential confounding bias. Analyses were adjusted for clustering within delivery hospital. RESULTS Only 58.3% (n=4275) of infants received all evidence based practices for which they were eligible. Infants with low gestational age, growth restriction, low Apgar scores, and who were born on the day of maternal admission to hospital were less likely to receive evidence based care. After adjustment, evidence based care was associated with lower in-hospital mortality (risk ratio 0.72, 95% confidence interval 0.60 to 0.87) and in-hospital mortality or severe morbidity, or both (0.82, 0.73 to 0.92), corresponding to an estimated 18% decrease in all deaths without an increase in severe morbidity if these interventions had been provided to all infants. CONCLUSIONS More comprehensive use of evidence based practices in perinatal medicine could result in considerable gains for very preterm infants, in terms of increased survival without severe morbidity.
Collapse
Affiliation(s)
- Jennifer Zeitlin
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, 75014, France
| | | | - Aurelie Piedvache
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, 75014, France
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Janusz Gadzinowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Patrick Van Reempts
- Department of Neonatology, Antwerp University Hospital, Antwerp; and Study Centre for Perinatal Epidemiology, Flanders, Brussels, Belgium
| | - Lene Huusom
- Department of Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Tom Weber
- Department of Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Stephan Schmidt
- Department of Obstetrics, University Hospital, Philipps University, Marburg, Germany
| | - Henrique Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | | | - Liis Toome
- Unit of Neonates and Infants, Tallinn Children's Hospital, Tallinn, Estonia; and University of Tartu, Tartu, Estonia
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Division of Paediatrics, Karolinska Institute, Stockholm, Sweden; and Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Beatrice Blondel
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, 75014, France
| | - Mercedes Bonet
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, 75014, France
| | | | - Rolf F Maier
- Children's Hospital, University Hospital, Philipps University, Marburg Germany
| |
Collapse
|
31
|
Patel PN, Banerjee J, Godambe SV. Resuscitation of extremely preterm infants - controversies and current evidence. World J Clin Pediatr 2016; 5:151-8. [PMID: 27170925 PMCID: PMC4857228 DOI: 10.5409/wjcp.v5.i2.151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/24/2015] [Accepted: 01/16/2016] [Indexed: 02/06/2023] Open
Abstract
Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitation and stabilisation of extremely preterm infants but there is a lack of evidence in the periviable (gestational age 23-25 wk) preterm subgroup. Presence of an experienced team during the delivery of extremely preterm infant to improve outcome is reviewed. Adaptation from foetal to neonatal cardiorespiratory haemodynamics is dependent on establishing an optimal functional residual capacity in the extremely preterm infants, thus enabling adequate gas exchange. There is sufficient evidence for a gentle approach to stabilisation of these fragile infants in the delivery room. Evidence for antenatal steroids especially in the periviable infants, delayed cord clamping, strategies to establish optimal functional residual capacity, importance of temperature control and oxygenation in delivery room in extremely premature infants is reviewed in this article.
Collapse
|
32
|
Oatley HK, Blencowe H, Lawn JE. The effect of coverings, including plastic bags and wraps, on mortality and morbidity in preterm and full-term neonates. J Perinatol 2016; 36 Suppl 1:S83-9. [PMID: 27109095 PMCID: PMC4848741 DOI: 10.1038/jp.2016.35] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/24/2015] [Indexed: 01/21/2023]
Abstract
Neonatal hypothermia is an important risk factor for mortality and morbidity, and is common even in temperate climates. We conducted a systematic review to determine whether plastic coverings, used immediately following delivery, were effective in reducing the incidence of mortality, hypothermia and morbidity. A total of 26 studies (2271 preterm and 1003 term neonates) were included. Meta-analyses were conducted as appropriate. Plastic wraps were associated with a reduction in hypothermia in preterm (⩽29 weeks; risk ratio (RR)=0.57; 95% confidence interval (CI) 0.46 to 0.71) and term neonates (RR=0.76; 95% CI 0.60 to 0.96). No significant reduction in neonatal mortality or morbidity was found; however, the studies were underpowered for these outcomes. For neonates, especially preterm, plastic wraps combined with other environmental heat sources are effective in reducing hypothermia during stabilization and transfer within hospital. Further research is needed to quantify the effects on mortality or morbidity, and investigate the use of plastic coverings outside hospital settings or without additional heat sources.
Collapse
Affiliation(s)
- H K Oatley
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - H Blencowe
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Maternal, Reproductive & Child Health, London School of Hygiene & Tropical Medicine, London, UK
| | - J E Lawn
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Maternal, Reproductive & Child Health, London School of Hygiene & Tropical Medicine, London, UK
- Saving Newborn Lives, Save the Children, Washington, DC, USA
| |
Collapse
|
33
|
Sharma D, Farahbakhsh N, Shastri S, Sharma P. Intrauterine growth restriction - part 2. J Matern Fetal Neonatal Med 2016; 29:4037-48. [PMID: 26979578 DOI: 10.3109/14767058.2016.1154525] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Small for gestational age (SGA) infants have been classically defined as having birth weight less than two standard deviations below the mean or less than the 10th percentile of a population-specific birth weight for specific gestational age, whereas intrauterine growth restriction (IUGR) has been defined as a rate of foetal growth that is less than normal for the population and for the growth potential of a specific infant. SGA infants have more frequent problems such as perinatal asphyxia, hypothermia, hypoglycaemia, polycythaemia and many more when compared with their appropriate for gestational age counterpart. They too have growth retardation and various major and subtle neurodevelopmental handicaps, with higher rates of perinatal and neonatal mortality. With the advent of newer technologies, even though the perinatal diagnosis of these SGA/IUGR foetuses has increased, but still perinatal morbidity and mortality rates are higher than normal foetuses and infants. In this part, we have covered neonatal IUGR classification, postnatal diagnosis, short-term and long-term complications faced by these IUGR infants.
Collapse
Affiliation(s)
- Deepak Sharma
- a Department of Pediatrics , Pt B.D. Sharma, Post Graduate Institute of Medical and Sciences , Rohtak , Haryana , India
| | | | - Sweta Shastri
- c Department of Pathology , N.K.P Salve Medical College , Nagpur , Maharashtra , India , and
| | | |
Collapse
|
34
|
English M, Karumbi J, Maina M, Aluvaala J, Gupta A, Zwarenstein M, Opiyo N. The need for pragmatic clinical trials in low and middle income settings - taking essential neonatal interventions delivered as part of inpatient care as an illustrative example. BMC Med 2016; 14:5. [PMID: 26782822 PMCID: PMC4717536 DOI: 10.1186/s12916-016-0556-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pragmatic randomized trials aim to examine the effects of interventions in the full spectrum of patients seen by clinicians who receive routine care. Such trials should be employed in parallel with efforts to implement many interventions which appear promising but where evidence of effectiveness is limited. We illustrate this need taking the case of essential interventions to reduce inpatient neonatal mortality in low and middle income countries (LMIC) but suggest the arguments are applicable in most clinical areas. DISCUSSION A set of basic interventions have been defined, based on available evidence, that could substantially reduce early neonatal deaths if successfully implemented at scale within district and sub-district hospitals in LMIC. However, we illustrate that there remain many gaps in the evidence available to guide delivery of many inpatient neonatal interventions, that existing evidence is often from high income settings and that it frequently indicates uncertainty in the magnitude or even direction of estimates of effect. Furthermore generalizing results to LMIC where conditions include very high patient staff ratios, absence of even basic technologies, and a reliance on largely empiric management is problematic. Where there is such uncertainty over the effectiveness of interventions in different contexts or in the broad populations who might receive the intervention in routine care settings pragmatic trials that preserve internal validity while promoting external validity should be increasingly employed. Many interventions are introduced without adequate evidence of their effectiveness in the routine settings to which they are introduced. Global efforts are needed to support pragmatic research to establish the effectiveness in routine care of many interventions intended to reduce mortality or morbidity in LMIC. Such research should be seen as complementary to efforts to optimize implementation.
Collapse
Affiliation(s)
- Mike English
- KEMRI-Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, 00100, Kenya.
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Jamlick Karumbi
- KEMRI-Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, 00100, Kenya.
- Ministry of Health, Nairobi, Kenya.
| | - Michuki Maina
- KEMRI-Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, 00100, Kenya.
| | - Jalemba Aluvaala
- KEMRI-Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, 00100, Kenya.
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
| | - Archna Gupta
- Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, Western Centre for Public Health and Family Medicine, London, Canada.
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, Western Centre for Public Health and Family Medicine, London, Canada.
| | - Newton Opiyo
- KEMRI-Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, 00100, Kenya.
| |
Collapse
|
35
|
Backes CH, Huang H, Iams JD, Bauer JA, Giannone PJ. Timing of umbilical cord clamping among infants born at 22 through 27 weeks' gestation. J Perinatol 2016; 36:35-40. [PMID: 26401752 PMCID: PMC5095613 DOI: 10.1038/jp.2015.117] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the safety, feasibility and efficacy of delayed cord clamping (DCC) compared with immediate cord clamping (ICC) at delivery among infants born at 22 to 27 weeks' gestation. STUDY DESIGN This was a pilot, randomized, controlled trial in which women in labor with singleton pregnancies at 22 to 27 weeks' gestation were randomly assigned to ICC (cord clamped at 5 to 10 s) or DCC (30 to 45 s). RESULTS Forty mother-infant pairs were randomized. Infants in the ICC and DCC groups had mean gestational ages (GA) of 24.6 and 24.4 weeks, respectively. No differences were observed between the groups across all available safety measures, although infants in the DCC group had higher admission temperatures than infants in the ICC group (97.4 vs. 96.2 °F, P=0.04). During the first 24 h of life, blood pressures were lower in the ICC group than in the DCC group (P<0.05), despite a threefold greater incidence of treatment for hypotension (45% vs. 12%, P<0.01). Infants in the ICC group had increased numbers of red blood transfusions (in first 28 days of life) than infants in DCC group (4.1±3.9 vs. 2.8±2.2, P=0.04). CONCLUSION Among infants born at an average GA of 24 weeks', DCC appears safe, logistically feasible, and offers hematological and circulatory advantages compared with ICC. A more comprehensive appraisal of this practice is needed.
Collapse
Affiliation(s)
- CH Backes
- The Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, USA
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Center for Perinatal Research and The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Obstetrics/Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - H Huang
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| | - JD Iams
- Department of Obstetrics/Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - JA Bauer
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| | - PJ Giannone
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
36
|
Enweronu-Laryea C, Dickson KE, Moxon SG, Simen-Kapeu A, Nyange C, Niermeyer S, Bégin F, Sobel HL, Lee ACC, von Xylander SR, Lawn JE. Basic newborn care and neonatal resuscitation: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy Childbirth 2015; 15 Suppl 2:S4. [PMID: 26391000 PMCID: PMC4577863 DOI: 10.1186/1471-2393-15-s2-s4] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND An estimated two-thirds of the world's 2.7 million newborn deaths could be prevented with quality care at birth and during the postnatal period. Basic Newborn Care (BNC) is part of the solution and includes hygienic birth and newborn care practices including cord care, thermal care, and early and exclusive breastfeeding. Timely provision of resuscitation if needed is also critical to newborn survival. This paper describes health system barriers to BNC and neonatal resuscitation and proposes solutions to scale up evidence-based strategies. METHODS The maternal and newborn bottleneck analysis tool was applied by 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks" that hinder the scale up of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for BNC and neonatal resuscitation. RESULTS Eleven of the 12 countries provided grading data. Overall, bottlenecks were graded more severely for resuscitation. The most severely graded bottlenecks for BNC were health workforce (8 of 11 countries), health financing (9 out of 11) and service delivery (7 out of 9); and for neonatal resuscitation, workforce (9 out of 10), essential commodities (9 out of 10) and service delivery (8 out of 10). Country teams from Africa graded bottlenecks overall more severely. Improving workforce performance, availability of essential commodities, and well-integrated health service delivery were the key solutions proposed. CONCLUSIONS BNC was perceived to have the least health system challenges among the seven maternal and newborn intervention packages assessed. Although neonatal resuscitation bottlenecks were graded more severe than for BNC, similarities particularly in the workforce and service delivery building blocks highlight the inextricable link between the two interventions and the need to equip birth attendants with requisite skills and commodities to assess and care for every newborn. Solutions highlighted by country teams include ensuring more investment to improve workforce performance and distribution, especially numbers of skilled birth attendants, incentives for placement in challenging settings, and skills-based training particularly for neonatal resuscitation.
Collapse
Affiliation(s)
- Christabel Enweronu-Laryea
- Department of Child Health, School of Medicine and Dentistry, College of Health Sciences University of Ghana, Accra, PO Box 4236, Ghana
| | - Kim E Dickson
- Health Section, Programme Division, UNICEF Headquarters, 3 United Nations Plaza, New York, NY 10017, USA
| | - Sarah G Moxon
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Saving Newborn Lives, Save the Children, 2000 L Street NW, Suite 500, Washington, DC 20036, USA
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Aline Simen-Kapeu
- Health Section, Programme Division, UNICEF Headquarters, 3 United Nations Plaza, New York, NY 10017, USA
| | - Christabel Nyange
- Health Section, Programme Division, UNICEF Headquarters, 3 United Nations Plaza, New York, NY 10017, USA
- Ross University Medical School, 2300 SW 145th Avenue, Miramar, Florida 33027, USA
| | - Susan Niermeyer
- Section of Neonatology, University of Colorado School of Medicine, 13121 E. 17th Avenue, Aurora, CO 80045, USA
| | - France Bégin
- IYCN, UNICEF Headquarters, 3 United Nations Plaza, New York, NY 10017, USA
| | - Howard L Sobel
- Reproductive, Maternal, Newborn, Child and Adolescent Health, Division of NCD and Health through Life-Course, World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Anne CC Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Severin Ritter von Xylander
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Saving Newborn Lives, Save the Children, 2000 L Street NW, Suite 500, Washington, DC 20036, USA
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| |
Collapse
|
37
|
Lassi ZS, Middleton PF, Crowther C, Bhutta ZA. Interventions to Improve Neonatal Health and Later Survival: An Overview of Systematic Reviews. EBioMedicine 2015; 2:985-1000. [PMID: 26425706 PMCID: PMC4563123 DOI: 10.1016/j.ebiom.2015.05.023] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/20/2015] [Accepted: 05/22/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Evidence-based interventions and strategies are needed to improve child survival in countries with a high burden of neonatal and child mortality. An overview of systematic reviews can focus implementation on the most effective ways to increase child survival. METHODS In this overview we included published Cochrane and other systematic reviews of experimental and observational studies on antenatal, childbirth, postnatal and child health interventions aiming to prevent perinatal/neonatal and child mortality using the WHO list of essential interventions. We assessed the methodological quality of the reviews using the AMSTAR criteria and assessed the quality of the outcomes using the GRADE approach. Based on the findings from GRADE criteria, interventions were summarized as effective, promising or ineffective. FINDINGS The overview identified 148 Cochrane and other systematic reviews on 61 reproductive, maternal, newborn and child health interventions. Of these, only 57 reviews reported mortality outcomes. Using the GRADE approach, antenatal corticosteroids for preventing neonatal respiratory distress syndrome in preterm infants; early initiation of breastfeeding; hygienic cord care; kangaroo care for preterm infants; provision and promotion of use of insecticide treated bed nets (ITNs) for children; and vitamin A supplementation for infants from six months of age, were identified as clearly effective interventions for reducing neonatal, infant or child mortality. Antenatal care, tetanus immunization in pregnancy, prophylactic antimalarials during pregnancy, induction of labour for prolonged pregnancy, case management of neonatal sepsis, meningitis and pneumonia, prophylactic and therapeutic use of surfactant, continuous positive airway pressure for neonatal resuscitation, case management of childhood malaria and pneumonia, vitamin A as part of treatment for measles associated pneumonia for children above 6 months, and home visits across the continuum of care, were identified as promising interventions for reducing neonatal, infant, child or perinatal mortality. INTERPRETATION Comprehensive adoption of the above six effective and 11 promising interventions can improve neonatal and child survival around the world. Choice of intervention and degree of implementation currently depends on resources available and policies in individual countries and geographical settings. FUNDING This review was part of doctoral thesis which was funded by University of Adelaide, Australia.
Collapse
Affiliation(s)
- Zohra S. Lassi
- Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Australia
| | - Philippa F. Middleton
- Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Australia
| | - Caroline Crowther
- Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Australia
- Liggins Institute, University of Auckland, New Zealand
| | - Zulfiqar A. Bhutta
- Robert Harding Chair in Global Child Health & Policy Centre for Global Child Health Hospital for Sick Children, Toronto, Canada
- Center of Excellence for Women and Child Health, The Aga Khan University, Karachi, Pakistan
| |
Collapse
|
38
|
Chang HY, Sung YH, Wang SM, Lung HL, Chang JH, Hsu CH, Jim WT, Lee CH, Hung HF. Short- and Long-Term Outcomes in Very Low Birth Weight Infants with Admission Hypothermia. PLoS One 2015; 10:e0131976. [PMID: 26193370 PMCID: PMC4507863 DOI: 10.1371/journal.pone.0131976] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/09/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Neonatal hypothermia remains a common problem and is related to elevated morbidities and mortality. However, the long-term neurodevelopmental effects of admission hypothermia are still unknown. This study attempted to determine the short-term and long-term consequences of admission hypothermia in VLBW preterm infants. STUDY DESIGN This retrospective study measured the incidence and compared the outcomes of admission hypothermia in very low birth weight (VLBW) preterm infants in a tertiary-level neonatal intensive care unit. Infants were divided into the following groups: normothermia (36.5-37.5°C), mild hypothermia (36.0-36.4°C), moderate hypothermia (32.0-35.9°C), and severe hypothermia (< 32°C). We compared the distribution, demographic variables, short-term outcomes, and neurodevelopmental outcomes at 24 months of corrected age among groups. RESULTS We studied 341 infants: 79 with normothermia, 100 with mild hypothermia, 162 with moderate hypothermia, and 0 with severe hypothermia. Patients in the moderate hypothermia group had significantly lower gestational ages (28.1 wk vs. 29.7 wk, P < .02) and smaller birth weight (1004 g vs. 1187 g, P < .001) compared to patients in the normothermia group. Compared to normothermic infants, moderately hypothermic infants had significantly higher incidences of 1-min Apgar score < 7 (63.6% vs. 31.6%, P < .001), respiratory distress syndrome (RDS) (58.0% vs. 39.2%, P = .006), and mortality (18.5% vs. 5.1%, P = .005). Moderate hypothermia did not affect neurodevelopmental outcomes at 2 years' corrected age. Mild hypothermia had no effect on short-term or long-term outcomes. CONCLUSIONS Admission hypothermia was common in VLBW infants and correlated inversely with birth weight and gestational age. Although moderate hypothermia was associated with higher RDS and mortality rates, it may play a limited role among multifactorial causes of neurodevelopmental impairment.
Collapse
Affiliation(s)
- Hung-Yang Chang
- Department of Pediatrics, MacKay Memorial Hospital, Hsinchu Branch, Hsinchu, Taiwan
- Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Yi-Hsiang Sung
- Department of Pediatrics, MacKay Memorial Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Shwu-Meei Wang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
| | - Hou-Ling Lung
- Department of Pediatrics, MacKay Memorial Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Jui-Hsing Chang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
| | - Chyong-Hsin Hsu
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
| | - Wai-Tim Jim
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
| | - Ching-Hsiao Lee
- Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Hsiao-Fang Hung
- Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| |
Collapse
|
39
|
Skiöld B, Stewart M, Theda C. Predictors of unfavorable thermal outcome during newborn emergency retrievals. Air Med J 2015; 34:86-91. [PMID: 25733114 DOI: 10.1016/j.amj.2014.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 10/13/2014] [Accepted: 10/28/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Maintenance of normal body temperature is a challenge during transports. We aimed to identify predisposing factors for unfavorable thermal outcome during emergency retrievals of neonates. METHODS Demographic data and clinical variables for transports performed over a 2-year period were extracted from the Newborn Emergency Transport Service (Victoria, Australia) database. Arrival temperatures outside normothermia (36.5°-37.5°C) were defined as an unfavorable outcome. RESULTS Normothermia on arrival at the receiving hospital was achieved in 78% of 1,261 transports. The strongest predictor of unfavorable thermal outcome was an abnormal temperature at the start of the retrieval (odds ratio [OR] = 8.04; 95% confidence interval [CI], 5.91-10.95; P < .001) followed by very low weight on transport (< 1,500 g; OR = 2.49; 95% CI, 1.63-3.80; P < .001) and respiratory support (OR = 1.81; 95% CI, 1.29-2.54; P = .001). Medications (eg, inotropes and sedation/muscle relaxation) or central/peripheral venous/arterial lines were not significant predictors of outcome when temperature at retrieval start, weight at transport, and respiratory support were adjusted as cofactors. Mode of transport (road, fixed wing, or rotary wing aircraft) and outside temperature were not associated with thermal outcome. CONCLUSION Abnormal temperature at the start of the retrieval, very low transport weight, and respiratory support were strong predictors of unfavorable thermal outcome during neonatal emergency transports.
Collapse
Affiliation(s)
- Beatrice Skiöld
- Newborn Emergency Transport Service, Royal Children's Hospital, Melbourne, Victoria, Australia; Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Michael Stewart
- Newborn Emergency Transport Service, Royal Children's Hospital, Melbourne, Victoria, Australia; Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Christiane Theda
- Newborn Emergency Transport Service, Royal Children's Hospital, Melbourne, Victoria, Australia; Royal Women's Hospital, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia.
| |
Collapse
|
40
|
Developing sustainable global health technologies: insight from an initiative to address neonatal hypothermia. J Public Health Policy 2014; 36:24-40. [PMID: 25355235 DOI: 10.1057/jphp.2014.44] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Relative to drugs, diagnostics, and vaccines, efforts to develop other global health technologies, such as medical devices, are limited and often focus on the short-term goal of prototype development instead of the long-term goal of a sustainable business model. To develop a medical device to address neonatal hypothermia for use in resource-limited settings, we turned to principles of design theory: (1) define the problem with consideration of appropriate integration into relevant health policies, (2) identify the users of the technology and the scenarios in which the technology would be used, and (3) use a highly iterative product design and development process that incorporates the perspective of the user of the technology at the outset and addresses scalability. In contrast to our initial idea, to create a single device, the process guided us to create two separate devices, both strikingly different from current solutions. We offer insights from our initial experience that may be helpful to others engaging in global health technology development.
Collapse
|
41
|
Anderzén-Carlsson A, Lamy ZC, Tingvall M, Eriksson M. Parental experiences of providing skin-to-skin care to their newborn infant--part 2: a qualitative meta-synthesis. Int J Qual Stud Health Well-being 2014; 9:24907. [PMID: 25319747 PMCID: PMC4197398 DOI: 10.3402/qhw.v9.24907] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 11/14/2022] Open
Abstract
AIM To synthesize and interpret qualitative research findings focusing on parental experiences of skin-to-skin care (SSC) for newborn infants. BACKGROUND SSC induces many benefits for newborn infants and their parents. Three meta-analyses have been conducted on physiological outcomes, but no previous qualitative meta-synthesis on parental experiences of SSC has been identified. DESIGN The present meta-synthesis was guided by the methodology described by Paterson and co-workers. DATA SOURCES Four databases were searched, without year or language limitations, up until December 2013. Manual searches were also performed. The searches and subsequent quality appraisal resulted in the inclusion of 29 original qualitative papers from 9 countries, reporting experiences from 401 mothers and 94 fathers. REVIEW METHODS The meta-synthesis entails a meta-data analysis, analysis of meta-method, and meta-theory in the included primary studies. Based on the three analyses, the meta-synthesis represents a new interpretation of a phenomenon. The results of the meta-data analysis have been presented as a qualitative systematic review in a separate paper. RESULTS When synthesizing and interpreting the findings from the included analyses, a theoretical model of Becoming a parent under unfamiliar circumstances emerged. Providing SSC seems to be a restorative as well as an energy-draining experience. A supportive environment has been described as facilitating the restorative experience, whereas obstacles in the environment seem to make the provision of SSC energy-draining for parents. When the process is experienced as positive, it facilitates the growth of parental self-esteem and makes the parents ready to assume full responsibility for their child. CONCLUSION The results show that SSC can be interpreted not only as a family-including and important health care intervention but also in terms of actually becoming a parent. The process of becoming a parent in this specific situation is influenced by external factors in three different levels; family and friends, community, and society at large. The descriptions of providing SSC are similar to what has previously been described as the natural process of becoming a mother or a father.
Collapse
Affiliation(s)
- Agneta Anderzén-Carlsson
- Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden;
| | - Zeni C Lamy
- Departamento de Saúde Pública, Universidade Federal do Maranhão, Hospital Universitário, Sao Luis, Brazil
| | - Maria Tingvall
- Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden
| | - Mats Eriksson
- Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
42
|
Anderzén-Carlsson A, Lamy ZC, Eriksson M. Parental experiences of providing skin-to-skin care to their newborn infant--part 1: a qualitative systematic review. Int J Qual Stud Health Well-being 2014; 9:24906. [PMID: 25319746 PMCID: PMC4197399 DOI: 10.3402/qhw.v9.24906] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2014] [Indexed: 11/25/2022] Open
Abstract
AIM To describe parental experiences of providing skin-to-skin care (SSC) to their newborn infants. BACKGROUND SSC care for newborn infants has been reported to have positive physiological and psychological benefits to the infants and their parents. No systematic review regarding parental experiences has been identified. DESIGN In this first part of a meta-study, the findings of a systematic literature review on parental experience of SSC care are presented. DATA SOURCES Four databases were searched, without year or language limitations, up until December 2013. Manual searches were performed in reference lists and in a bibliography of the topic. REVIEW METHODS After a quality-appraisal process, data from the original articles were extracted and analysed using qualitative content analysis. RESULTS The systematic and manual searches led to the inclusion of 29 original qualitative papers from nine countries, reporting experiences from 401 mothers and 94 fathers. Two themes that characterized the provision of SSC emerged: a restoring experience and an energy-draining experience. CONCLUSION This review has added scientific and systematic knowledge about parental experiences of providing SSC. Further research about fathers' experiences is recommended.
Collapse
Affiliation(s)
- Agneta Anderzén-Carlsson
- Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden;
| | - Zeni Carvalho Lamy
- Departamento de Saúde Pública, Universidade Federal do Maranhão, Hospital Universitário, Sao Luis, MA, Brazil
| | - Mats Eriksson
- Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
43
|
Stevens J, Schmied V, Burns E, Dahlen H. Immediate or early skin-to-skin contact after a Caesarean section: a review of the literature. MATERNAL & CHILD NUTRITION 2014; 10:456-73. [PMID: 24720501 PMCID: PMC6860199 DOI: 10.1111/mcn.12128] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The World Health Organization and the United Nations International Children's Emergency Fund recommends that mothers and newborns have skin-to-skin contact immediately after a vaginal birth, and as soon as the mother is alert and responsive after a Caesarean section. Skin-to-skin contact can be defined as placing a naked infant onto the bare chest of the mother. Caesarean birth is known to reduce initiation of breastfeeding, increase the length of time before the first breastfeed, reduce the incidence of exclusive breastfeeding, significantly delay the onset of lactation and increase the likelihood of supplementation. The aim of this review is to evaluate evidence on the facilitation of immediate (within minutes) or early (within 1 h) skin-to-skin contact following Caesarean section for healthy mothers and their healthy term newborns, and identify facilitators, barriers and associated maternal and newborn outcomes. A range of electronic databases were searched for papers reporting research findings published in English between January 2003 and October 2013. Seven papers met the criteria. This review has provided some evidence that with appropriate collaboration skin-to-skin contact during Caesarean surgery can be implemented. Further evidence was provided, albeit limited, that immediate or early skin-to-skin contact after a Caesarean section may increase breastfeeding initiation, decrease time to the first breastfeed, reduce formula supplementation in hospital, increase bonding and maternal satisfaction, maintain the temperature of newborns and reduce newborn stress.
Collapse
Affiliation(s)
- Jeni Stevens
- School of Nursing and MidwiferyUniversity of Western SydneyPenrithNew South WalesAustralia
| | - Virginia Schmied
- School of Nursing and MidwiferyUniversity of Western SydneyPenrithNew South WalesAustralia
| | - Elaine Burns
- School of Nursing and MidwiferyUniversity of Western SydneyPenrithNew South WalesAustralia
| | - Hannah Dahlen
- School of Nursing and MidwiferyUniversity of Western SydneyPenrithNew South WalesAustralia
| |
Collapse
|
44
|
Salam RA, Mansoor T, Mallick D, Lassi ZS, Das JK, Bhutta ZA. Essential childbirth and postnatal interventions for improved maternal and neonatal health. Reprod Health 2014; 11 Suppl 1:S3. [PMID: 25177795 PMCID: PMC4145857 DOI: 10.1186/1742-4755-11-s1-s3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Childbirth and the postnatal period, spanning from right after birth to the following several weeks, presents a time in which the number of deaths reported still remain alarmingly high. Worldwide, about 800 women die from pregnancy- or childbirth-related complications daily while almost 75% of neonatal deaths occur within the first seven days of delivery and a vast majority of these occur in the first 24 hours. Unfortunately, this alarming trend of mortality persists, as 287,000 women lost their lives to pregnancy and childbirth related causes in 2010. Almost all of these deaths were preventable and occurred in low-resource settings, pointing towards dearth of adequate facilities in these parts of the world. The main objective of this paper is to review the evidence based childbirth and post natal interventions which have a beneficial impact on maternal and newborn outcomes. It is a compilation of existing, new and updated interventions designed to help physicians and policy makers and enable them to reduce the burden of maternal and neonatal morbidities and mortalities. Interventions during the post natal period that were found to be associated with a decrease in maternal and neonatal morbidity and mortality included: advice and support of family planning, support and promotion of early initiation and continued breastfeeding; thermal care or kangaroo mother care for preterm and/or low birth weight babies; hygienic care of umbilical cord and skin following delivery, training health personnel in basic neonatal resuscitation; and postnatal visits. Adequate delivery of these interventions is likely to bring an unprecedented decrease in the number of deaths reported during childbirth.
Collapse
Affiliation(s)
- Rehana A Salam
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Tarab Mansoor
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Dania Mallick
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zohra S Lassi
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
45
|
Lassi ZS, Mansoor T, Salam RA, Das JK, Bhutta ZA. Essential pre-pregnancy and pregnancy interventions for improved maternal, newborn and child health. Reprod Health 2014; 11 Suppl 1:S2. [PMID: 25178042 PMCID: PMC4145858 DOI: 10.1186/1742-4755-11-s1-s2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The statistics related to pregnancy and its outcomes are staggering: annually, an estimated 250000-280000 women die during childbirth. Unfortunately, a large number of women receive little or no care during or before pregnancy. At a period of critical vulnerability, interventions can be effectively delivered to improve the health of women and their newborns and also to make their pregnancy safe. This paper reviews the interventions that are most effective during preconception and pregnancy period and synergistically improve maternal and neonatal outcomes. Among pre-pregnancy interventions, family planning and advocating pregnancies at appropriate intervals; prevention and management of sexually transmitted infections including HIV; and peri-conceptual folic-acid supplementation have shown significant impact on reducing maternal and neonatal morbidity and mortality. During pregnancy, interventions including antenatal care visit model; iron and folic acid supplementation; tetanus Immunisation; prevention and management of malaria; prevention and management of HIV and PMTCT; calcium for hypertension; anti-Platelet agents (low dose aspirin) for prevention of Pre-eclampsia; anti-hypertensives for treating severe hypertension; management of pregnancy-induced hypertension/eclampsia; external cephalic version for breech presentation at term (>36 weeks); management of preterm, premature rupture of membranes; management of unintended pregnancy; and home visits for women and children across the continuum of care have shown maximum impact on reducing the burden of maternal and newborn morbidity and mortality. All of the interventions summarized in this paper have the potential to improve maternal mortality rates and also contribute to better health care practices during preconception and periconception period.
Collapse
Affiliation(s)
- Zohra S Lassi
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Tarab Mansoor
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
46
|
Lassi ZS, Kumar R, Mansoor T, Salam RA, Das JK, Bhutta ZA. Essential interventions: implementation strategies and proposed packages of care. Reprod Health 2014; 11 Suppl 1:S5. [PMID: 25178110 PMCID: PMC4145859 DOI: 10.1186/1742-4755-11-s1-s5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In an effort to accelerate progress towards achieving Millennium Development Goal (MDG) 4 and 5, provision of essential reproductive, maternal, newborn and child health (RMNCH) interventions is being considered. Not only should a state-of-the-art approach be taken for services delivered to the mother, neonate and to the child, but services must also be deployed across the household to hospital continuum of care approach and in the form of packages. The paper proposed several packages for improved maternal, newborn and child health that can be delivered across RMNCH continuum of care. These packages include: supportive care package for women to promote awareness related to healthy pre-pregnancy and pregnancy interventions; nutritional support package for mother to improve supplementation of essential nutrients and micronutrients; antenatal care package to detect, treat and manage infectious and noninfectious diseases and promote immunization; high risk care package to manage preeclampsia and eclampsia in pregnancy; childbirth package to promote support during labor and importance of skilled birth attendance during labor; essential newborn care package to support healthy newborn care practices; and child health care package to prevent and manage infections. This paper further discussed the implementation strategies for employing these interventions at scale.
Collapse
Affiliation(s)
- Zohra S Lassi
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rohail Kumar
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Tarab Mansoor
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
47
|
Shamba D, Schellenberg J, Hildon ZJL, Mashasi I, Penfold S, Tanner M, Marchant T, Hill Z. Thermal care for newborn babies in rural southern Tanzania: a mixed-method study of barriers, facilitators and potential for behaviour change. BMC Pregnancy Childbirth 2014; 14:267. [PMID: 25110173 PMCID: PMC4141124 DOI: 10.1186/1471-2393-14-267] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 08/06/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Hypothermia contributes to neonatal morbidity and mortality in low-income countries, yet little is known about thermal care practices in rural African settings. We assessed adoption and community acceptability of recommended thermal care practices in rural Tanzania. METHODS A multi-method qualitative study, enhanced with survey data. For the qualitative component we triangulated birth narrative interviews with focus group discussions with mothers and traditional birth attendants. Results were then contrasted to related quantitative data. Qualitative analyses sought to identify themes linked to a) immediately drying and wrapping of the baby; b) bathing practices, including delaying for at least 6 hours and using warm water; c) day to day care such as covering the baby's head, covering the baby; and d) keeping the baby skin-to-skin. Quantitative data (n = 22,243 women) on the thermal care practices relayed by mothers who had delivered in the last year are reported accordingly. RESULTS 42% of babies were dried and 27% wrapped within five minutes of birth mainly due to an awareness that this reduced cold. The main reason for delayed wrapping and drying was not attending to the baby until the placenta was delivered. 45% of babies born at a health facility and 19% born at home were bathed six or more hours after birth. The main reason for delayed bathing was health worker advice. The main reason for early bathing believed that the baby is dirty, particularly if the baby had an obvious vernix as this was believed to be sperm. On the other hand, keeping the baby warm and covered day-to-day was considered normal practice. Skin-to-skin care was not a normalised practice, and some respondents wondered if it might be harmful to fragile newborns. CONCLUSION Most thermal care behaviours needed improving. Many sub-optimal practices had cultural and symbolic origins. Drying the baby on birth was least symbolically imbued, although resisted by prioritizing of the mothers. Both practical interventions, for instance, having more than one attendant to help both mother and baby, and culturally anchored sensitization are recommended.
Collapse
Affiliation(s)
- Donat Shamba
- />Ifakara Health Institute, P.O. Box 78373, Dar Es Salaam, Tanzania
| | - Joanna Schellenberg
- />Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Zoe Jane-Lara Hildon
- />Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- />Saw Swee Hock School of Public Health, National University Singapore, Singapore, Singapore
- />Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Irene Mashasi
- />Ifakara Health Institute, P.O. Box 78373, Dar Es Salaam, Tanzania
| | - Suzanne Penfold
- />Ifakara Health Institute, P.O. Box 78373, Dar Es Salaam, Tanzania
- />Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Marcel Tanner
- />Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Tanya Marchant
- />Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Zelee Hill
- />Center for International Health and Development, Institute of Child Health, University College London, London, UK
| |
Collapse
|
48
|
Changes over time in delivery room management of extremely low birth weight infants in Italy. Resuscitation 2014; 85:1072-6. [DOI: 10.1016/j.resuscitation.2014.04.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/26/2014] [Indexed: 11/18/2022]
|
49
|
McCall E, Alderdice F, Halliday H, Johnston L, Vohra S. Challenges of Minimizing Heat Loss at Birth: A Narrative Overview of Evidence-Based Thermal Care Interventions. ACTA ACUST UNITED AC 2014. [DOI: 10.1053/j.nainr.2014.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
50
|
Abstract
There is a paucity of data to support recommendations for stabilization and resuscitation of the periviable neonate in the delivery room. The importance of delivery at a tertiary center with adequate experience, resuscitation team composition, and training for a periviable birth is reviewed. Evidence for delayed cord clamping, delivery room temperature stabilization, strategies to establish functional residual capacity, and adequate ventilation as well as oxygen use in the delivery room is generally based on expert consensus, physiologic plausibility, as well as data from slightly more mature extremely low gestational-age neonates. Little is known about optimal care in the delivery room of these most fragile infants, and thus the need for research remains critical.
Collapse
Affiliation(s)
- Myra H Wyckoff
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas 75390-9063, TX.
| |
Collapse
|