The Golden 28 Days of Child Survival

Extended Perinatal Mortality Audit in a Rural Hospital in India

OBJECTIVE

The aim of the study is to describe the status of perinatal mortality (PM) in an Indian rural hospital.

STUDY DESIGN

Retrospective analysis of data was compiled from PM meetings (April 2017 to December 2018) following "Making Every Baby Count: audit and review of stillbirths and neonatal deaths (ENAP or Every Newborn Action Plan)."

RESULTS

The study includes 8,801 livebirths, 105 stillbirths (SBs); 74 antepartum stillbirths [ASBs], 22 intrapartum stillbirths [ISBs], and nine unknown timing stillbirths [USBs]), 39 neonatal deaths or NDs (perinatal death or PDs 144). The higher risks for ASBs were maternal age >34 years, previous history of death, and/or SBs. Almost half of the PDs could be related with antepartum complications. More than half of the ASB were related with preeclampsia/eclampsia and abruptio placentae; one-third of the ISB were related with preeclampsia/eclampsia and gestational hypertension, fetal growth restriction, and placental dysfunction. The main maternal conditions differed between PDs (p = 0.005). The main causes of the ND were infections, congenital malformations, complications of prematurity, intrapartum complications, and unknown. The stillbirth rate was 11.8/1,000 births, neonatal mortality rate 4.4/1,000 livebirths, and perinatal mortality rate 15.8/1,000 births.

CONCLUSION

This is the first study of its kind in Andhra Pradesh being the first step for the analysis and prevention of PM.

KEY POINTS

· Many conditions that lead to stillbirths are linked to neonatal deaths and PM has been outside of the global parameters from the last decades.. · This is the first study following International Classification of Disease perinatal mortality codes and the audit of ENAP in Andhra Pradesh.. · Extended PM and mortality are mainly caused by similar preventable and treatable conditions..

Early newborn bathing and associated factors among mothers in Afar Region, Northeast Ethiopia

BACKGROUND

Delaying newborn bathing for 24 h after childbirth protects the baby from hypothermia, infection and hypoglycaemia and provides an opportunity for mother-baby emotional bonding. However, no previously published study has investigated the early newborn bathing practices of pastoral mothers in Ethiopia. This study aims to investigate early newborn bathing and associated factors among mothers in Afar Region, Northeast Ethiopia.

METHODS

Institution-based cross-sectional study was conducted from May to June 2021. A systematic random sampling technique was used to recruit 386 mothers, and the data collection was performed using an interviewer-administered questionnaire. Multivariable logistic regression modelling was used to examine the association between explanatory variables (including sociodemographic, obstetric, health service and health literacy factors) and early newborn bathing.

RESULTS

The overall prevalence of early newborn bathing among postpartum mothers was 73.1% with a 95% confidence interval (CI) from 68.4 to 77.5%. Mothers who attained college or higher education [adjusted odds ratio (AOR) = 0.21; 95% CI 0.06-0.66], those who were from urban areas (AOR = 0.19; 95% CI 0.09-0.42) and those who gave birth using operational delivery (e.g. caesarean section and instrumental delivery) (AOR = 0.01; 95% CI 0.01-0.04) were less likely to practice early newborn bathing.

CONCLUSION

The practice of early newborn bathing was unacceptably high in pastoral communities of the Afar Region. There is a need for interventions specifically targeting at uneducated and rural mothers as part of the implementation to improve the essential newborn care practices of mothers in pastoral communities in Ethiopia.

Short- and Long-term Outcomes of Group B Streptococcus Invasive Disease in Mozambican Children: Results of a Matched Cohort and Retrospective Observational Study and Implications for Future Vaccine Introduction

BACKGROUND

Invasive group B Streptococcus disease (iGBS) in infancy, including meningitis or sepsis, carries a high risk of mortality and neurodevelopmental impairment (NDI). We present data on iGBS from 2 decades of surveillance in Manhiça, Mozambique, with a focus on NDI.

METHODS

Morbidity surveillance databases in a rural Mozambican district hospital were screened for iGBS cases. From February 2020 to March 2021, surviving iGBS patients (n = 39) plus age- and sex-matched children without iGBS (n = 119) were assessed for neurocognitive development, vision, and hearing. The role of GBS in stillbirths and infant deaths was investigated using minimally invasive tissue sampling (MITS).

RESULTS

Ninety iGBS cases were included, with most children being <3 months of age (85/90). The in-hospital case fatality rate was 14.4% (13/90), increasing to 17.8% (3 additional deaths) when considering mortality during the 6 months postdiagnosis. Fifty percent of the iGBS exposed infants and 10% of those unexposed showed any NDI. Surviving GBS conferred a 11-fold increased adjusted odds of moderate/severe NDI (odds ratio, 2.8 [95% confidence interval, .92-129.74]; P = .06) in children aged 0-5 years. For older children (6-18 years), no differences in NDI were found between exposed and unexposed. Motor domain was the most affected among young GBS survivors. Three stillbirths and 4 early neonatal deaths (of the 179 MITS performed) were attributed to iGBS.

CONCLUSIONS

In absence of preventive strategies, such as intrapartum antibiotics, iGBS remains a significant cause of perinatal and infant disease and death. GBS also causes major longer-term neurodevelopmental sequelae, altogether justifying the need for maternal GBS vaccination strategies to increase perinatal and infant survival.