Current perspectives and practices of newborn vitamin K administration in low and middle income countries

An assessment of immediate newborn care readiness and availability in Nepal

BACKGROUND

Global neonatal mortality necessitates access to immediate newborn care interventions. In Nepal, disparities persist in the readiness and availability of newborn care services within health facilities.

OBJECTIVE

This study aimed to assess this status and compare facilities that had implemented an intensive newborn resuscitation capacity building and retention programme in the past five years with those that had not.

METHODS

Our observational cross-sectional study involved 154 health facilities across Nepal. Through on-site inspections and maternal log reviews, we evaluated the immediate newborn care readiness and availability.

RESULTS

The mean immediate newborn care intervention availability score of 52.8% (SE = 21.5) and the readiness score averaged 79.6% (SE = 12.3). Encouragingly, 96% of facilities ensured newborns were dried and wrapped for warmth, and 69.9% provided newborn resuscitation. Practices such as delayed cord clamping (42.0%), skin-to-skin contact (28.6%), and early breastfeeding (63.5%) showed room for improvement. Only 16.1% of health facilities administered Vitamin K1 prophylaxis.Domain-specific scores demonstrated a high level of facility readiness in infrastructure (97.5%), medicine, equipment, and supplies (90.6%), and staff training (90.9%), but a lower score for neonatal resuscitation aids (28.8%). Disparities in readiness and availability were evident, with rural areas and the Madhesh province reporting lower scores. Variations among health facility types revealed provincial and private hospitals outperforming local-level facilities. A positive association was observed between the LDSC/SSN mentoring programme and both the readiness and availability of immediate newborn care services.

CONCLUSION

This study highlights the gap between healthcare facility readiness and the actual availability of immediate newborn care interventions in Nepal. Addressing disparities and barriers, particularly in rural areas and local-level facilities, is crucial for improving neonatal survival. The positive link between the LDSC/SSN programme and service availability and facility readiness emphasises the significance of targeted training and mentorship programmes in enhancing newborn care across Nepal.

Take the Shot: A Review of Vitamin K Deficiency

Vitamin K is essential for the process of coagulation. In its absence, severe and sometimes fatal bleeding events can occur, especially in newborns. Vitamin K prophylaxis at birth has been shown to prevent morbidity and mortality associated with vitamin K deficiency bleeding (VKDB) and is recommended by multiple organizations including the American Academy of Pediatrics and the World Health Organization. Pediatricians should feel comfortable explaining the risks and benefits of vitamin K prophylaxis to families and should be equipped to recognize signs of VKDB, especially given increasing rates of parental refusal. This article aims to improve understanding of VKDB, including prevention, early recognition, and treatment. [Pediatr Ann. 2023;52(2):e42-e45.].

Physicians’ Opinion and Practice of Vitamin K Administration at Birth in Romania

(1) Background. Vitamin K is recommended worldwide as a standard of care for the prophylaxis of vitamin-K-deficiency bleeding (VKDB). This is also a standard practice in Romania, but due to the rising number of refusals by parents of basic interventions in the neonatal period, we aimed to assess the Romanian neonatologists’ opinions and current practice regarding vitamin K administration at birth. (2) Methods. We designed and conducted an electronic survey addressed to 110 physicians working in Romanian hospitals. (3) Results. Half of respondents are accustomed to receiving refusals for vitamin K administration once or twice a year. When parents refuse vitamin K administration, they usually refuse other neonatal interventions, according to 90.9% of the responding physicians, and this situation has occurred more frequently during the last two years. The number of refusals and especially their increase are more frequent in level III hospitals (p = 0.0304, p = 0.0036, respectively). Only 22.7% of the physicians responded that they would recommend an oral preparation of vitamin K in the absence of intramuscular prophylaxis. (4) Conclusion. Efforts should be made to address parents’ concerns and to have available alternatives to the intramuscular administration of vitamin K.

Facility level factors that determine consistent delivery of essential newborn care at health centers in Ethiopia

BACKGROUND

Essential newborn care (ENC) is a package of interventions which should be provided for every newborn baby regardless of body size or place of delivery immediately after birth and should be continued for at least the seven days that follows. Even though Ethiopia has endorsed the implementation of ENC, as other many counties, it has been challenged. This study was conducted to measure the level of essential newborn care practice and identify health facility level attributes for consistent delivery of ENC services by health care providers.

METHODS

This study employed a retrospective cross-sectional study design in 425 facilities. Descriptive statistics were formulated and presented in tables. Binary logistic regression was employed to assess the statistical association between the outcome variable and the independent variables. All variables with p < 0.2 in the bivariate analysis were identified as candidate variables. Then, multiple logistic regression analysis was performed using candidate variables to determine statistically significant predictors of the consistent delivery of ENC by adjusting for possible confounders.

RESULTS

A total of 273, (64.2%), of facilities demonstrated consistent delivery of ENC. Five factors-availability of essential obstetrics drugs in delivery rooms, high community score card (CSC) performances, availability of maternity waiting homes, consistent partograph use, and availability of women-friendly delivery services were included in the model. The strongest predictor of consistent delivery of essential newborn care (CD-ENC) was consistent partograph use, recording an odds ratio of 2.66 (AOR = 2.66, 95%CI: 1.71, 4.13). Similarly, providing women-friendly services was strongly associated with increased likelihood of exhibiting CD-ENC. Furthermore, facilities with essential obstetric drugs had 1.88 (AOR = 1.88, 95%CI: 1.15, 3.08) times higher odds of exhibiting consistent delivery of ENC.

CONCLUSION

The delivery of essential newborn care depends on both health provider and facility manager actions and availability of platforms to streamline relationships between the clients and health facility management.