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Background Modern advanced technologies in the neonatal intensive care unit (NICU) have created more noise sources of varying frequencies and intensities, increasing the risk of hearing loss in infants. This study aimed to determine the effect of earmuffs on neonatal behavior. Materials and Methods This study was conducted in the 13-bed level III-A NICU of a 1,000-bed tertiary care teaching hospital. Preexperimental, one-group pretest, posttest design was adopted in the study. Twenty-seven neonates were selected using nonprobability and purposive sampling techniques. The noise level was checked using a dosimeter (sound level meter SL-4030), the baseline variables were collected, and earmuffs were applied to the neonates for 2 hours in the morning and 2 hours in the evening for 3 consecutive days. An observational checklist was used to assess neonatal behavior. Results The mean age in days was 2.19 ± 0.96, the mean weight in kilograms was 2.92 ± 0.43, and the mean gestational week was 37.56 ± 1.50. The mean sound level in the NICU was 56.7 + 14, which was higher than the NICU's recommended noise level. The most noise-generating events and equipment found in NICU were human-made noise and ventilator bubbling sounds. There was a significant difference in the mean behavioral score among neonates using earmuffs, as the " p -value was < 0.05." However, there was no association between pretest neonatal behavior with baseline data (p > 0.05). Conclusion This study revealed that wearing earmuffs had a beneficial impact on enhancing newborn behavior. [ABSTRACT FROM AUTHOR]

Background: Fasting before elective anesthesia care is a standardized practice worldwide. The aim is to decrease the risk of aspiration leading to pulmonary complications such as aspiration pneumonitis during anesthesia care. There are different guidelines for elective preoperative fasting in children. However, there is insufficient literature measuring gastric emptying time after breast milk or formula milk feeding in infants. Objective: This study used gastric ultrasound to determine the gastric emptying time for breast milk and formula milk in children below 6 months of age. We also compared the calculated gastric volumes among breast‐fed and formula milk‐fed based on Schmitz's and Spencer's formula. Materials and methods: This prospective observational study was conducted at a tertiary care center in India between November (2017–2019). A total of 52 infants less than 6 months of age were recruited. The study population was divided into two groups (breast‐fed and formula milk‐fed) of 26 patients each. Ultrasound was used to measure the antral cross‐sectional area of the stomach and to calculate the gastric volume using the two classical formulas (Schmitz and Spencer's). Gastric emptying was reported when the bull's eye appearance of the gastric antrum was seen or when the antral cross‐sectional area was less than 3.07 cm2. Results: The number of breast‐fed children whose antral cross‐sectional was greater than 3.07 cm2 (cut‐off value for aspiration risk) beyond 1 h was 14/26 (53.84%) while none (0) children went beyond 3 h. The number of formula‐fed children whose antral cross‐sectional was greater than 3.07 cm2 beyond 1 h was 17/26 (65.38%) while one child (3.84%) went beyond 3 h. Using Schmitz's formula, mean (SD) gastric emptying times were 0.35 ± 0.68 h (95% CI 0.35 ± 0.185, range 0.165–0.535) for breast‐fed patients and 0.35 ± 0.69 h (95% CI 0.35 ± 0.188, range 0.162–0.538) for formula‐fed patients, and were thus neither clinically nor statistically different (p =.73) Using Spencer's formula, the mean gastric emptying times were 0.12 ± 0.33 h (95% CI 0.12 ± 0.09, range 0.03–0.21) for breast‐fed patients and 0.04 ± 0.20 h (95% CI 0.04 ± 0.05, range −0.01 to 0.09) for formula‐fed patients, and were also neither clinically nor statistically different p =.13. Conclusion: In our series, the gastric emptying times in breast‐fed and formula‐fed infants less than 6 months old were similar. Our results support the fasting guidelines of the European Society of Anaesthesiology and Intensive Care 2022, that is, 3 h for breastfeeding and 4 h for formula milk feeding. In addition, this shows that the Schmitz's and Spencer's formulae used to calculate the gastric volume based on ultrasound measurement of the antral cross‐sectional area are not comparable in infants less than 6 months. [ABSTRACT FROM AUTHOR]

Familial Haemophagocytic Lymphohistiocytosis (FHL) is an autosomal recessive disorder characterised by a hyperinflammatory state due to widespread infiltration of organs with macrophages and lymphocytes. Haemophagocytic Lymphohistiocytosis (HLH) presents with fever, hepatosplenomegaly, cytopenia, hyperferritinemia and haemophagocytosis in the reticuloendothelial tissues causing multi organ failure with fatal outcome. HLH is rare in neonates with an incidence of 1 in 50,000 to 1 in 150,000. FHL is diagnosed based on clinical criteria, biochemical abnormalities, and genetic mutation. Mutations involving the gene STXBP2 contributes to around 10% of cases of FHL and there are only a few cases of FHL5 reported from India. A six-week-old neonate presented with sepsis which was unresponsive to antibiotics. Persistent fever, bicytopenia, hepatosplenomegaly and laboratory tests made us suspect HLH, and evaluate further with whole exome sequencing. FHL5 was diagnosed based on the identification of homozygous missense mutation in exon 3 of STXBP2 gene (chr19: 7642803_7642803delA). The baby succumbed to sepsis and multi organ failure. HLH should be considered in the differential diagnosis of any sick infant who presents with prolonged fever, sepsis unresponsive to antibiotics and an unusual clinical course. [ABSTRACT FROM AUTHOR]

The prevalence of gestational diabetes has been reported as 17.9% in Tamil Nadu. Women with GDM are at a higher risk of developing pregnancy complications and adverse outcomes. This study was conducted to look at various outcomes of infants of diabetic mothers to enable better management and focus on prevention. This was a hospital-based non-concurrent cohort study. Women diagnosed with gestational diabetes using the IADSPG guidelines were identified and the outcomes of their neonates were studied. The association between various factors and poor outcomes was estimated using the Chi-square test and odds ratio. The prevalence of GDM was 24.2%, with an increase in maternal age and obesity. LGA (Large-for-Gestational-Age) babies were more in the group with diabetes. This was statistically significant with both GDM (RR 3.39) and Pregestational diabetes (RR 8.93). Among the neonates with GDM or pregestational diabetes, the RR for perinatal asphyxia was 0.98 (0.61-1.58) and 2.07 (0.52-8.28), respectively. There were more neonates with hypoglycemia as well as jaundice in the groups being treated with drugs. The risk of neonatal complications increases when diabetic women are on drugs for glycemic control than those on a diet alone. Our study's overall incidence of neonatal complications was lower than most studies. [ABSTRACT FROM AUTHOR]

Introduction Neonatal encephalopathy (NE) is associated with a high risk of adverse neurological outcomes. Several neurodiagnostic tests have been evaluated to predict the prognosis. Amplitude integrated Electroencephalogram (aEEG) is now being commonly used for bedside evaluation of cerebral function. There is limited data on the role of aEEG for prognostication in NE, from resource-limited settings. Objective To evaluate the predictive ability of aEEG for abnormal neurological outcomes in neonatal encephalopathy or neonates with encephalopathy. Methods Neonates above 35 weeks of gestation admitted to NICU in a tertiary care hospital with a diagnosis of encephalopathy were enrolled. Clinical characteristics severity of encephalopathy and seizures were recorded. Amplitude integrated recording was started at admission and continued till recovery of trace to normal or for 10 days. The primary outcome was death or abnormal neurological status at 3–6 months of age. The study was registered in the Clinical Trial Registry of India (CTRI/2013/05/003612) Results The incidence of NE was 6% of total admission. Moderate and severe encephalopathy occurred in 58 and 39% of babies respectively. Hypoxic-ischemic encephalopathy was the most common cause. Clinical seizures occurred in 91% of cases. An abnormal aEEG trace was observed in 51 (76.1%) infants with NE. For adverse neurological outcomes at an age average of 4.5 months of age, aEEG had a sensitivity, specificity, NPV, and PPV of 100, 54.2, 100, and 77.5, respectively. Conclusions Clinical staging and aEEG has good predictive ability to detect an adverse neurological outcome. aEEG improves the ability to predict abnormal outcome in babies with moderate encephalopathy. Early recovery of aEEG abnormality correlates with better neurodevelopmental outcomes. KEY MESSAGES What’s known: aEEG is a useful modality to assess neurodevelopmental outcomes however data from developing countries is lacking. What’s new: aEEG monitoring in babies in neonatal encephalopathy may improve the prediction of abnormal neurological outcomes in babies with moderate encephalopathy. [ABSTRACT FROM AUTHOR]

A systematic review of four relevant databases for articles about the use of telemedicine to expand access to neonatal and reproductive health in rural India was conducted. The objective of this review was to identify initiatives with evidence for potential public health benefits through large-scale implementation. Of 3,098 records from the initial search, 1,415 records were selected for further review after removing duplicates. Eight reports that met the eligibility and inclusion criteria were included in the final review. Selected studies included two types of interventions, direct telemedicine interventions with patients and indirect telemedicine interventions through frontline health care workers. Among studies involving direct telemedicine interventions, 22.4% of the collective health and knowledge outcomes (n = 49) showed statistically significant improvement in the intervention group, whereas 38.0% of the collective health and knowledge outcomes (n = 50) in the studies involving indirect telemedicine intervention showed statistically significant improvement. This systematic review suggested that the use of telemedicine interventions may have a statistically significant effect through educational impacts. There were certain limitations around the use of technology and training that may have undermined the effects of some of the outcomes. This systematic review did not receive any funding. [ABSTRACT FROM AUTHOR]

Background: Annually 2.5 million infants die in the first 28 days of life, with a significant regional distribution disparity. An estimated 80% of those could be saved if neonatal resuscitation were correctly and promptly initiated. A barrier to achieving the target is the knowledge and skills of healthcare workers.Purpose: The objective of this cluster randomized trial was to assess the improvement and retention of resuscitation skills of nurses, midwives, and birth attendants in 2 birth centers serving 60 villages in rural India using high-frequency, low-dose training.Results: There was a significant difference ( P < .05) between the groups in the rate of resuscitation, with 18% needing resuscitation in the control group and 6% in the intervention group. The posttest scores for knowledge retention at the final 8-month evaluation were significantly better in the intervention group than in the control group (intervention group mean rank 19.4 vs control group mean rank 10.3; P < .05). The success rate of resuscitation was not significantly different among the groups.Implications For Practice: Improved knowledge retention at 8 months and the lower need for resuscitation in the intervention group support the efficacy of the high-frequency, low-dose education model of teaching in this setting.Implications For Research: Replication of these findings in other settings with a larger population cohort is needed to study the impact of such intervention on birth outcomes in low-resource settings. [ABSTRACT FROM AUTHOR]

Background: Education of '108' ambulance personnel involved in transporting neonates may improve outcomes. We assessed i) perceptions/practices of '108' ambulance personnel for transporting neonates, ii) clinical parameters of transported neonates at arrival, and iii) outcomes such as survival/mortality and NICU stay (before and after skill-based educational intervention)., Methods: We conducted a single-arm intervention study (pre-and post) over 18 months. We assessed the perceptions and practices of 77 ambulance personnel on neonatal transport pre- versus post-intervention. Checklists assessed ambulance equipment availability/usage in both phases. We compared clinical parameters and outcomes of transported neonates between the pre-intervention (n=62) and post-intervention (n=53) phases. We analyzed data using SPSS version 25., Results: Post-intervention, there was a significant reduction in the levels of hypothermia (p < 0.001), hypoglycemia (p=0.010), and prolonged capillary refill time (p=0.042), along with improvement in the use of intravenous fluids (p <0.001), a reduction in the positivity of umbilical swab growth (p=0.002) and in the duration of NICU stay (p = 0.001), significant improvement ( p < 0.001) in the perceptions/practices of ambulance personnel towards neonatal transport. There was an improvement in the ambulance equipment availability/usage post-intervention., Conclusions: The perceptions and practices of the '108' ambulance towards transporting neonates had significantly improved post-educational intervention. Further, a significant decrease in hypothermia, hypoglycemia, and duration of NICU stay was seen in neonates transported post-intervention., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Kalyan S et al.)

Despite progress in reducing the infant mortality in India, the neonatal mortality decline has been slower, necessitating concerted efforts to achieve Sustainable Development Goal-3. A promising strategy aiming to prevent neonatal sepsis in high-risk, vulnerable, low birth weight neonates through an innovative intervention includes probiotic supplementation. This article communicates the decision by the ProSPoNS trial investigators to establish a Central Endpoint Adjudication Committee (CEAC) as an addendum to the protocol published in Trials in 2021 for the purpose of clarifying the primary outcome. In the published protocol, the study hypothesis and primary objective are based on "sepsis," the primary outcome has been specified as sepsis/PSBI, whereas the sample size estimation was performed based on the "physician diagnosed sepsis." To align all the three above, the investigators meeting, held on 17th-18th August 2023, at MGIMS Sevagram, Wardha, deliberated and unanimously agreed that "physician diagnosed sepsis" is the primary study outcome which includes sepsis/PSBI. The CEAC, chaired by an external subject expert and members including trial statistician, a microbiologist, and all site principal investigators will employ four criteria to determine "physician diagnosed sepsis": (1) blood culture status, (2) sepsis screen status, (3) PSBI/non-PSBI signs and symptoms, and (4) the clinical course for each sickness event. Importantly, this clarification maintains consistency with the approved study protocol (Protocol No. 5/7/915/2012 version 3.1 dated 14 Feb 2020), emphasizing the commitment to methodological transparency and adherence to predefined standards. The decision to utilize the guidance of a CEAC is recommended as the gold standard in multicentric complex clinical trials to achieve consistency and accuracy in assessment of outcomes.Trial registrationClinical Trial Registry of India (CTRI) CTRI/2019/05/019197. Registered on 16 May 2019., (© 2024. The Author(s).)

Introduction: Birth weight is not only strongly associated with foetal and neonatal mortality but also with stunted growth. Low Intelligence Quotient (IQ) in childhood, obesity and diabetes in adulthood. Despite all measures taken, the prevalence of Low Birth Weight (LBW) is not significantly decreasing in Southeast Asia (from 33% in 2000 to 27 % in 2015 according to United Nations Children's Fund (UNICEF) 2019 data). And added to the surprise in UNICEF data from countries for LBW, from A-Z data, (A-Z data is data of LBW countries whose name starts from letter A to letter Z in alphabetical order) India was not included, because data from India was partial. Aim: To determine whether maternal socio-demographic factors determine LBW in newborns. Materials and Methods: A prospective hospital-based observational study was carried out in the Obstetrics and Gynaecology Department of Mahatma Gandhi Institute of Medical sciences, Sewagram, Wardha, M.S, Maharashtra India, among 500 consecutive, consenting pregnant women from December 2017 to November 2019. Socio-demographic parameters and neonate birth weight were recorded. Statistical analysis was done by inferential statistics using Chi-square test and z-test with significance value considered at <0.05. Results: Among the total 500 subjects 162 (32.4%) had LBW and 338 Normal Birth Weight (NBW). By using Chi-square test, statistically significant difference was found in parity, socioeconomic condition, mother's education, area of residence of both the LBW and NBW groups (X2=6.49, p=0.039; X2=51.32, p=0.0004; X2=12.95, p=0.012; X2=5.66, p=0.017), respectively. (significant at p<0.05). Conclusion: The prevalence of LBW babies was 32.4%. Rural areas, low socio-economic condition, education, were significant determinants of LBW. As the parity increases birth weight increases. [ABSTRACT FROM AUTHOR]

Background: Retinopathy of Prematurity (ROP) is a preventable cause of childhood blindness. India accounts for nearly 10% of the worldwide estimate of blindness and visual impairment due to ROP. Nurses are pillars of neonatal intensive care units (NICUs) and play a critical role in the prevention and management of ROP. The primary aim of this study was to evaluate the effect of developmentally supportive education program on knowledge regarding prevention and management of ROP among nurses working in NICU. Materials and Methods: A hospital based pre-experimental, one group pre-test–post-test study was carried out among 32 staff nurses working in the NICU of a tertiary care center during January to February 2019. Knowledge regarding the prevention and management of ROP was assessed before and after the implementation of developmentally supportive education program using a structured knowledge questionnaire. Results: Pre-test knowledge score was mean (Standard Deviation [SD]) 9.00 (3.68) and after the educational program post-test knowledge score was found to be mean (SD) 14.53 (2.39). Paired t-test was used to evaluate the effect of developmentally supportive education program and was found to be statistically significant (t32 = 10.09, p < 0.001). Conclusions: Developmentally supportive educational program can be used as an effective intervention for improving the knowledge regarding ROP among nurses in NICU. [ABSTRACT FROM AUTHOR]

Background: Kangaroo mother care (KMC) can substantially enhance overall survival of low birthweight babies. In a large randomized controlled trial, we recently showed that supporting mothers to provide community initiated KMC (ciKMC) can reduce mortality among infants up to 180 days of life by 25% (hazard ratio (HR) 0.75). With the current analysis, we aimed to explore if ciKMC promotion leads to increased inequity in survival. Methods: In the trial we randomized 8402 low birthweight babies to a ciKMC (4480 babies) and a control (3922 babies) arm, between 2015 and 2018 in Haryana, India. We estimated the difference in concentration indices, which measure inequality, between babies in the ciKMC and control arms for survival until 180 days of life. Further, we compared the effect of ciKMC promotion across subgroups defined by socioeconomic status, caste, maternal literacy, infant's sex, and religion. Results: Our intervention did not increase survival inequity, as the concentration index in the ciKMC arm of the trial was 0.05 (95% CI -0.07 to 0.17) lower than in the control arm. Survival impact was higher among those belonging to the lower two wealth quintiles, those born to illiterate mothers and those belonging to religions other than Hindu. Conclusions: We found that ciKMC promotion did not increase inequity in survival associated with wealth. The beneficial impact of ciKMC tended to be larger among vulnerable groups. Supporting mothers to provide KMC at home to low birthweight babies will not increase and could indeed reduce inequities in infant survival. Trial registration: ClinicalTrials.gov, NCT02653534. Registered January 12, 2016—Retrospectively registered. [ABSTRACT FROM AUTHOR]

Objective: To elucidate characteristics among neonates and their mothers who were discharged against medical advice (DAMA), providers' perspectives on DAMA and the effect of an intervention to reduce DAMA in a tertiary care hospital in South India. Methods: We conducted a mixed‐methods study to identify neonates at risk of DAMA. We reviewed charts of neonates and their mothers who were DAMA and conducted logit regression analysis to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) to determine associations with DAMA. We conducted focus group discussions with nurses and doctors. We developed an intervention that included family counselling, supplemental funds for hospital bills and involving family members to reduce DAMA. Results: Of 10 834 neonates, 179 (1.7%) were DAMA over the study period. Maternal characteristics associated with DAMA included higher previous parity (aOR 1.9, 95% CI 1.1–2.3, P = 0.001). Mothers who received antenatal care had lower odds of DAMA (aOR 0.2, 95% CI 0.1–0.7, P = 0.039). Neonates with lower birth weight (aOR 2.1, 95% CI 1.7–9.4, P = 0.002) and congenital malformations (aOR 3.3, 95% CI 1.1–5.3, P = 0.005) also had higher odds of DAMA. The most commonly cited reasons for DAMA were financial constraints, inadequate counselling and perceived poor prognosis. The average monthly number of neonates who were DAMA decreased from 3.6 (1.6%) to 1.5 (0.6%) after our multi‐pronged intervention. Conclusions: Neonates with severe illness and poor prognosis had higher odds of DAMA. A multi‐pronged intervention demonstrated reductions in the rates of DAMA. This intervention may be trialled in similar settings to reduce DAMA. [ABSTRACT FROM AUTHOR]

Introduction: The association between maternal obesity and increased neonatal morbidity in infants of diabetic mothers needs to be evaluated. Aims: The objective of the study is to compare the immediate neonatal complications of obese and nonobese gestational diabetic mothers (GDM). Settings and Design: This prospective case–control study was conducted in a tertiary care center in Kerala, South India, between July 1, 2019 and January 1, 2020. Methods: Six hundred and seventy-seven obstetric patient records of deliveries conducted between July 1, 2019 and January 1, 2020 were reviewed. Neonatal outcomes of infants of obese and nonobese diabetic mothers (categorization based on prepregnancy body mass index [BMI]) were compared with the healthy neonatal controls born during the study period. Outcomes studied were neonatal intensive care unit (NICU) admission, NICU stay more than 7 days, hypoglycemia, respiratory distress, phototherapy, and proportion of small for gestational age in infants of diabetic mothers. Statistical Analysis Used: Statistical analysis used odds ratio and Chi-square tests. Results: One hundred and sixty-eight were found to be eligible to be included in the study. Eighty-four GDM cases were matched with 84 healthy control mothers. Hypoglycemia (P = 0.001), respiratory distress (P = 0.002), NICU admission (P = 0.001), prolonged NICU stay, and phototherapy were significantly associated with those mothers who had high BMI. Conclusions: Compared to infants of nonobese GDMs, infants of obese GDMs are at higher risk of hypoglycemia, respiratory distress, phototherapy, and NICU stay more than 7 days. [ABSTRACT FROM AUTHOR]

Background/Objectives: India has largest children population, but unfortunately this population has serious enemies in the form of communicable diseases. Diarrhoeal disease is among the biggest killer of children in India. Our objective is to analyze the trend of mortality among Indian children due to diarrhea across three major age groups. Further to suggest ways to manage this disease effective by adopting preventive measures. Methods/Statistics: Secondary data is analyzed by using ANOVA, Tukey Post hoc and partial correlation. Results & Findings: There is a significant difference between the mortality due to diarrhoeal diseases of children across Neonatal, Post neonatal and under five years of age in India. Post hoc test suggests that mortality due to diarrhoeal diseases of children is significant for Post neonatal and neonatal age group. There is very strong and negative correlation has been found between Gross Domestic Product (GDP) of India and mortality due to diarrhoeal diseases in children. Applications: Better management practices are suggested to control number of cases of diarrhoeal diseases based on children age groups. To fight against Post neonatal and children under five years of age mortality due to diarrhoeal diseases, government in India can frame similar but effective policies. [ABSTRACT FROM AUTHOR]

Various factors lead to neonatal mortality, in which transport of neonates play an important role in mortality and morbidity of neonates. In India neonatal transport has not developed well. Many sick neonates succumb during transport or become very serious during transport. Transport duration, type of transport, treatment given during transport, if pretransport treatment received, maintenance of hemodynamic stability, maintenance of temperature and blood sugars during transport is essential for reducing the mortality of the baby. Regionalizing neonatal care, will help in deciding the transport of neonates from one centre to an higher level of care. Hence a well-organized transport system should be in place for the transport of the sick neonates. This review article discusses about the neonatal transport and its implications. [ABSTRACT FROM AUTHOR]

Objective: To present evaluation of a quality improvement program for Accredited Social Health Activists (ASHAs).Methods: This community intervention trial was conducted in Ballabgarh, India during 2012-2014 with two Primary Health Center (PHC) areas being the intervention areas and two PHC areas being non-intervention areas receiving standard care. Interventions included two-day training in technical and communication skills of ASHAs followed by supportive supervision in the field. Intervention was evaluated by comparing pre and post training scores, feedback from postnatal mothers and a difference-in-difference (DID) analysis on baseline and endline knowledge-practice survey of recently delivered mothers with 95% confidence intervals.Results: Only 11.1% ASHAs addressed specific barriers for adopting healthy behaviors. Sixty eight (91.8%) ASHAs attended the training after which knowledge improved by 33.3% (p < 0.001). ASHAs in intervention areas were rated by mothers (n = 69) to have better communication skills (81.2% vs. 59.7%, p = 0.005), make more postnatal visits (52.2% vs. 22.2%; p < 0.001), give advice on newborn care (64% vs. 50.5%; p < 0.001) as compared to standard care area ASHAs. Endline survey (n = 1360) showed a significant improvement in frequency of antenatal visits (0.26;0.19-0.33), knowledge about free transport (0.12;0.05-0.18), better cord-care practices (0.15;0.07-0.22), kangaroo mother care (0.19;0.13-0.25), delayed first bath (0.13;0.06-0.20), restrictive handling (0.11;0.06-0.15) and hand-washing (0.19;0.13-0.25).Conclusions: Quality improvement program can help improve ASHA's performance which in turn can address higher neonatal mortality in India. [ABSTRACT FROM AUTHOR]

Background: India has made tremendous progress in reducing MMR by77 % since 1990, but still efforts are required to keep it up to achieve the new SDG target. Postnatal care is one of the interventions that can help the country to realize this aspiration. Present study is done to highlight this aspect of maternal care. Aims and Objectives: To assess utilization of postnatal care services among women residing in urban slums of Dehradun and factors affecting it. Materials and methods: A community based cross-sectional study was carried out among recently delivered mothers, residing in urban slums. 488 women were studied by systematic random sampling with the help of pre-tested questionaire. Data analysis was done using statistical software. Results: Out of 488 women, 52.5% received postnatal care at least once within first 48 hours of delivery. Only 76(15.5%) received all recommended PNC visits. 83(17%) reported to have some health problems after delivery. Socio-economic status, Education, number of ANC visits, place of delivery, type of delivery, and perceived health problem after delivery were found to be significant factors affecting postnatal care utilization. Conclusion: The study shows low level of complete utilization of postnatal care among women. Therefore, mothers should be educated about its importance to reduce both maternal and neonatal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Introduction: India is a country of large children population, with a very high children mortality rate. Acute Respiratory Infection (ARI) is one of the biggest killer of infants and children in India. Objective: current research is conducted to find out the difference in the mortality of Neonatal, Post neonatal and Children under five years of age due to ARI. Further we are interested to find out the relationship between per capita gross national income and mortality of children under five years of age due to ARI. Originality: Very few studies have been conducted to find out the difference in mortality due to ARI across different age groups of infants/children. Material & Method: Secondary data is analyzed by using ANOVA, Tukey Post hoc and partial correlation. Results & discussion: There is a significant difference between the mortality due to ARI of children across Neonatal, Post neonatal and under five years of age in India. Post hoc test suggests that mortality due to ARI of children is not significant for Post neonatal and children under five years of age. There is very strong and negative correlation has been found between per capita gross national product of India and mortality due to ARI in children. Applications: Current research would help policy makers to make effective policies in public health domain. Further it gives idea to improve economic condition to reduce mortality due to ARI. Conclusion: To fight against Post neonatal and children under five years of age mortality due to ARI, government in India can frame similar but effective policies. [ABSTRACT FROM AUTHOR]

As per the survey conducted by UNICEF in 2018, more than 6 lakh neonatal deaths occur in India which makes India to stand in the worst rank of 12 among 52 developing or undeveloped countries. Also, every day an average of 7,000 neonatal deaths occur worldwide. A new born baby can survive outside of the mother's womb with the help of baby incubator, provided the required environment to be maintained by incubator for premature baby to sustain. But in recent time, improper incubator design, short circuit in incubator, gas leakage inside the incubator has caused accidental deaths of premature babies. This paper deals with the low cost neonatal incubator system that monitors neonatal vital parameters like pulse rate, body temperature and incubator parameters like moisture, oxygen percentage and light intensity. These parameters are monitored and moisture, oxygen percentage and light intensity are controlled with proposed incubator. These parameters are also sent to the hospital staff through IoT (Internet of Things), so that immediate action can be initiated to take proper care of neonatal that ensures safety to the neonatal (infant's) life by maintaining incubator parameters as required. In this paper in addition to these, one more important feature is included that is phototherapy to treat jaundice in new born. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the knowledge, practices, and factors related to essential newborn care among mothers in a rural community in northern part of India and test its association with accredited social health activists (ASHAs) visits during antenatal and postnatal care. Methods: The study represents the formative phase of the community intervention trial for reducing neonatal mortality implemented in Ballabgarh block of Faridabad district, Haryana, India. Mothers who delivered within 1-6 months in 2012 in rural Ballabgarh before the interview were interviewed at home for knowledge and practices (KP) related to cord care, breastfeeding, thermal care, baby handling, and healthcare seeking including danger signs and free ambulance services. A KP score of 14 was derived from these domains and a score above 9 was taken as adequate. A logistic regression was used to test the hypothesis that ASHA visits were related to the higher knowledge among mothers when adjusted for other confounders. Results: Of the 1298 mothers, 42.3% (39.7-45.1) did not apply anything on umbilicus; 8.7% (7.3-10.4) were kept in skin-to-skin contact; 65% (62.3-67.6) were exclusively breastfed for 1st month; and 29.7 (27.2-32.3) first bathed their baby within 3 days to. 41% (38.7-44.1) of mothers were rated to have adequate KP. The KP score was significantly less in mothers who delivered at home (adjusted odds ratio [AOR]: 1.78; 95% confidence interval [CI]: 1.22-2.59), or underwent cesarean section (AOR: 1.67; 95% CI: 1.12-2.53) or did not have contact with ASHA (AOR: 1.64; 95% CI: 1.17-2.29). Conclusion: There is a considerable KP gap in the community. Strengthening and scaling up of ASHA visits could prove to be beneficial for modifying high-risk newborn care norms and practices. [ABSTRACT FROM AUTHOR]

• Sharp decline of under-five mortality rate in Bihar since 2006 (launch of Janani Suraksha Yojana). • Mortality is worst in the flood affected, north-eastern districts of Bihar. • 83 % deaths occur in 12 months among all deaths under-five years in Bhagalpur. • 70% deaths happen in the first seven days among all infant deaths in Bhagalpur. • Wealth status and house types are the strong correlates of under-five deaths in Bhagalpur. The first objective is to examine the trends, patterns and socio-demographic factors associated with the under-five mortality in Bihar and Bhagalpur district. The second objective is to study the geographical differences in under-five mortality in Bihar. The study uses both secondary and primary data. The information of under-five mortality drawn from the secondary sources i.e. Sample Registration System (SRS) for 1981–2013 and the National Family Health Survey for 2015–16. The primary data was collected in 2019 from Bhagalpur district of Bihar. Trends of under-five mortality rates in Bihar are presented in line graphs. The spatial distribution of under-five mortality rates is presented in maps. Cox-proportional hazard model and logistic regression models are applied to assess the socioeconomic and demographic correlates of under-five mortality in Bihar and in Bhagalpur district respectively. Under-five mortality rate has decreased significantly since 2006 in Bihar, still it remains higher than the national average. Geographical patterns show the under-five deaths were disproportionately high in north-eastern regions of Bihar. This pattern of under-five mortality rates is considerably varied across the selected socioeconomic and demographic characteristics. The findings confirm that the mother's nutritional status (BMI) and level of education, wealth status, and caste were significant factors of under-five mortality. The regression analysis show that the likelihood of under-five mortality was 1.2 times higher among the women who are underweight, who belong to the scheduled caste compared to their counterparts. Besides, the female children are more likely to die during their childhood than their male counterparts. Similar patterns also found in Bhagalpur district. The study reveals that under-five mortality is a serious public health concern in Bihar and Bhagalpur. The high under-five mortality in the study area is associated to poverty, maternal illiteracy and malnutrition, and geographical regions of Bihar. The flood prone north-eastern parts of Bihar experiencing higher under-five mortality compared to other parts. To reduce under-five mortality in Bihar as well as Bhagalpur, women's education, work involvement, and empowerment need to be prioritised to achieve the sustainable development goal-3 by 2030. [ABSTRACT FROM AUTHOR]

Despite progress made in recent decades, infant and neonatal mortality rates (NMRs) in India have remained high compared to neighbouring developing countries. This study aims at establishing quantitative links between the relatively slow progress in fight against neonatal death at national level and strikingly varying mortality patterns at sub-national level. It appears that the tempo and quantum of reductions in neonatal mortality have been inconsistent across time, states, and urban and rural sub-populations. Decompositions have shown that the total NMR decrease in India, since the early 1980s has been largely driven by mortality changes in poorer states and rural areas, whereas compositional changes had negligible impact. The disparity in NMRs across the sub-populations which had been declining earlier stabilised in the 2000s. These disparities produce a heavy burden of avoidable death. While the mortality excess in poorer states and rural areas constitutes the core of bulk of excess deaths, some richer states, and urban areas, also show unexpected slower mortality decreases. However, the experience of the two states of Kerala and Tamil Nadu highlights the potential for declines in NMRs in low-income settings with sensible health and social policies. [ABSTRACT FROM PUBLISHER]

Objective: To evaluate the effect of maternal iron deficiency anemia (IDA) on fetal thrombopoiesis.Methods: In this prospective observational study, maternal and cord blood iron status parameters (serum iron, serum ferritin, total iron-binding capacity, and transferrin saturation), and platelet indices, such as, absolute platelet count (APC), mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit, were estimated in a convenient sample of 142 mothers with IDA (hemoglobin <11 g/dl and serum ferritin <12 ng/ml) and an equal number of healthy non-anemic (hemoglobin ≥11 g/dl) mothers, who delivered singleton live neonates at term gestation. Mothers with antenatal thrombocytopenia, infections, inflammatory conditions, pregnancy-induced hypertension and neonates with perinatal asphyxia, sepsis and congenital malformations were excluded.Results: For statistical analysis, the IDA group was further subdivided into mild-to-moderate (hemoglobin 7-10.9 g/dl) and severe (hemoglobin <7 g/dl) anemia. Cord blood APC and PDW were comparable between non-anemic and mild-to-moderate anemic mothers (242,550 ± 54,320/μL vs. 235,260 ± 34,620/μL for APC and 16.2 ± 1.4 vs. 16.4 ± 1.8 fl for PDW, respectively), but in severe IDA group, cord blood APC and PDW were significantly lower (74,520 ± 12,380/μL and 17.8 ± 2.1 fl, respectively, p < 0.001). MPV and plateletcrit were comparable. None of the study neonates had a platelet count <30,000/μL or showed any evidence of clinical bleeding.Conclusions: Neonates born to mothers with severe IDA had moderate thrombocytopenia with increased PDW, though no change was observed in MPV and plateletcrit. Further studies should be carried out to identify the cause and consequences of this observation. [ABSTRACT FROM AUTHOR]

In India, the high neonatal and infant mortality rate is due in part to an increasing number of preterm and low birth weight (LBW) infants. Given the immaturity of immune system, these infants are at an increased risk of hospitalization and mortality from vaccine-preventable diseases (VPDs). In this narrative review, we screened the scientific literature for data on the risk of VPDs, vaccination delay and factors related to it in Indian preterm and LBW infants. Although routine childhood vaccinations are recommended regardless of gestational age or birth weight, vaccination is often delayed. It exposes these infants to a higher risk of infections, their associated complications, and death. After-birth complications, lack of awareness of recommendations, vaccine efficacy and effectiveness and concerns related to safety are some of the common barriers to vaccination. Awareness campaigns might help substantiate the need for (and value of) vaccination in preterm and LBW infants.

Highlights: [•] Ours is the first epidemiological report from India on risk factors of Autism Spectrum Disorder. [•] We conducted a large population based case-cohort study across India. [•] Out of 25 factors evaluated, advanced maternal age, fetal distress, gestational respiratory infections, labor complications, pre-term birth, neonatal jaundice, delayed birth cry and birth asphyxia were significantly associated with the risk of ASD. [•] These conditions can independently and collectively exert their effect as risk factors, adding important country specific information to existing literature. [ABSTRACT FROM AUTHOR]

Erythroderma a life-threatening entity during the first one month, and many a time, a manifestation of genodermatosis, immune deficiency, psoriasis, metabolic diseases, and infections. Atopic dermatitis presenting as erythroderma is usually observed later, after this one-month period, and hence not a common differential for neonatal exfoliative dermatitis. Although a rare entity, there is a paucity of studies on this and in contrast to adults, some may manifest as cardinal signs of primary disease conditions. [ABSTRACT FROM AUTHOR]

Although sepsis is a major cause of morbidity and mortality among newborns in resource-poor countries, little data are available from rural areas on culture-proven sepsis. The aim of the present study was to provide information in this regard. The study reports results on the incidence and aetiology of neonatal sepsis cases admitted to a facility in a rural area in eastern India. Blood culture was done for all babies, with suspected clinical sepsis, who were admitted to the sick newborn care unit at Suri where the study was conducted during March 2009--August 2010. A standard form was used for collecting clinical and demographic data. In total, 216 neonatal blood culture samples were processed, of which 100 (46.3%) grew potential pathogens. Gram-negative infection was predominant (58/100 cases) mainly caused by enteric Gram-negative bacteria. Klebsiella pneumoniae was the most common Gram-negative isolate. The emergence of fungal infection was observed, with 40% of the infection caused by yeast. Gram-negative organisms exhibited 100% resistance to ampicillin, cefotaxime, and gentamicin. Amikacin and co-trimoxazole showed 95% (n=57) resistance, and ciprofloxacin showed 83.3% (n=50) resistance among the Gram-negative bacteria. Carbapenem showed emerging resistance (n=4; 6.6%). Results of analysis of risk factors showed an extremely significant association between gestation and sepsis and gender and sepsis. Gastrointestinal symptoms were highly specific for fungal infections. One-third of babies (n=29), who developed culture-positive sepsis, died. Blood culture is an investigation which is frequently unavailable in rural India. As a result, empirical antibiotic therapy is commonly used. The present study attempted to provide data for evidence-based antibiotic therapy given to sick newborns in such rural units. The results suggest that there is a high rate of antibiotic resistance in rural India. Urgent steps need to be taken to combat this resistance. [ABSTRACT FROM AUTHOR]

Objective:To examine the association between breast-feeding initiation time and neonatal mortality in India, where breast-feeding initiation varies widely from region to region.Study Design:Data were collected as part of a community-based, randomized, placebo-controlled trial of the impact of vitamin A supplementation in rural villages of Tamil Nadu, India. Multivariate binomial regression analysis was used to estimate the association between neonatal mortality and breast-feeding initiation time (<12 h, 12 to 24 h, >24 h) among infants surviving a minimum of 48 h.Result:Among 10 464 newborns, 82.1% were first breast-fed before 12 h, 13.8% were breast-fed between 12 and 24 h, and 4.1% were breast-fed after 24 h. After adjusting for birth weight, gestational age and other covariates, late initiators (>24 h) were at ∼78% higher risk of death (relative risk=1.78 (95% confidence interval (CI)=1.03 to 3.10)). There was no difference in mortality risk when comparing babies fed in the first 12 h compared with the second 12 h after birth.Conclusion:Late (>24 h) initiation of breast-feeding is associated with a higher risk of neonatal mortality in Tamil Nadu. Emphasis on breast-feeding promotion programs in low-resource settings of India where early initiation is low could significantly reduce neonatal mortality. [ABSTRACT FROM AUTHOR]

Objective:To determine the accuracy and acceptability of a handheld scale prototype designed for nonliterate users to classify newborns into three weight categories (2500 g; 2000 to 2499 g; and <2000 g).Study Design:Weights of 1100 newborns in Uttar Pradesh, India, were measured on the test scale and validated against a gold standard. Mothers, family members and community health stakeholders were interviewed to assess the acceptability of the test scale.Result:The test scale was highly sensitive and specific at classifying newborn weight (normal weight: 95.3 and 96.3%, respectively; low birth weight: 90.4 and 99.2%, respectively; very low birth weight: 91.7 and 98.4%, respectively). It was the overall agreement of the community that the test scale was more practical and easier to interpret than the gold standard.Conclusion:The BIRTHweigh III scale accurately identifies low birth weight and very low birth weight newborns to target weight-specific interventions. The scale is extremely practical and useful for resource-poor settings, especially those with low levels of literacy.Journal of Perinatology (2007) 27, 602–608; doi:10.1038/sj.jp.7211797; published online 23 August 2007 [ABSTRACT FROM AUTHOR]

Objective:Medical audit is a widely promoted strategy in hospitals, but experience within community settings is scant. Community neonatal death audit is a form of audit, which involves a systematic analysis of the quality of care provided in the home, danger sign recognition and care seeking decision making for neonatal illness. This research was conducted in Uttar Pradesh, India, to investigate the feasibility and cultural acceptability of community neonatal death audits.Study Design:During November–December 2004, we conducted three in-depth interviews with family members of deceased neonates, and six focus group discussions with family and community members. Three approaches were evaluated: in-depth interview with the family before engaging them in an audit with the community; preliminary meeting to build rapport with the family and community before conducting an audit; and audit with the family and community in a single focus group. Approaches were interactive processes, involving the community, to identify avoidable factors in a particular death and discuss solutions.Result:Carried out in a culturally sensitive and non-punitive manner, community neonatal death audit was found to be acceptable and feasible. All approaches provoked formal investigation by community members, and stimulated sharing of views, leading to the self-discovery that community perception was a cumulatively amplified effect of individual perceptions. Presence of an educated/experienced community member or health worker served as a catalyst. No one optimal approach was identified.Conclusion:Community neonatal audit is an acceptable approach that shows promise as an effective intervention for improving neonatal health outcomes.Journal of Perinatology (2007) 27, 556–564; doi:10.1038/sj.jp.7211788; published online 19 July 2007 [ABSTRACT FROM AUTHOR]

Objective: Two-thirds of women globally give birth at home, yet little data are available on use of skin-to-skin care (STSC) in the community. We describe the acceptability of STSC in rural Uttar Pradesh, India, and measured maternal, newborn, and ambient temperature in the home in order to inform strategies for introduction of STSC in the community. Study design: Community-based workers in intervention clusters implemented a community mobilization and behavior change communication program that promoted birth preparedness and essential newborn care, including adoption of STSC, with pregnant mothers, their families, and key influential community members. Acceptance of STSC was assessed through in-depth interviews and focus groups, and temperature was measured during home visits on day of life 0 or 1. Results: Incidence of hypothermia (<36.5°C) was high in both low birth weight (LBW) and normal birth weight (NBW) infants (49.2%, (361/733) and 43% (418/971), respectively). Mean body temperature of newborns was lower (P<0.01) in ambient temperatures <20°C (35.9±1.4°C, n=225) compared to ⩾20°C (36.5±0.9°C, n=1450). Among hypothermic newborns, 42% (331/787) of their mothers had a lower temperature (range -6.7 to 0.1°C, mean difference 0.4±1.2°C). Acceptance of STSC was nearly universal. No adverse events from STSC were reported. STSC was perceived to prevent newborn hypothermia, enhance mother's capability to protect her baby from evil spirits, and make the baby more content. Conclusion: STSC was highly acceptable in rural India when introduced through appropriate cultural paradigms. STSC may be of benefit for all newborns and for many mothers as well. New approaches are needed for introduction of STSC in the community compared to the hospital. [ABSTRACT FROM AUTHOR]

Group B Streptococcus (GBS) causes pneumonia, meningitis and sepsis in neonates. The current distribution pattern of GBS serotypes in developing countries such as India, China and Brazil is not clear. In order to appropriately plan for vaccination programs to address the burden of this disease in these countries, prospective population based studies are urgently needed. In our discussions, we focused on India, China and Brazil because of the membership of our workgroup, but data on other countries are also presented here. Further studies in developing countries are needed so as to better formulate appropriate public health interventions., (Copyright © 2013. Published by Elsevier Ltd.)

Neonates experience painful procedures during routine care. Orally administered, sweet tasting solutions are commonly used in management of neonatal pain. We conducted a double-blind randomized control trial in neonates admitted to Neonatal Intensive Care Unit of Shri Krishna Hospital, Karamsad-Gujarat-India, of lingual administration of 25% dextrose vs. no intervention, to evaluate reduction of pain following oropharyngeal infant feeding tube insertions. Pain was assessed using Premature Infant Pain Profile score. Almost all the patients in the control group (98%) experienced moderate-to-severe pain as compared with the intervention group (71%). Mean Premature Infant Pain Profile score was statistically significantly lower in the intervention group (8.21) as compared with control group (10.31). (p < 0.001, 95% CI 1.090-3.102). Lingual 25% dextrose is an effective analgesic for relieving pain during orogastric tube insertion.

Tetanus is caused by a neurotoxin produced by Clostridium tetani (C. tetani), a spore-forming bacterium. Infection begins when tetanus spores are introduced into damaged tissue. Tetanus is characterized by muscle rigidity and painful muscle spasms caused by tetanus toxin's blockade of inhibitory neurons that normally oppose and modulate the action of excitatory motor neurons. Maternal and neonatal tetanus (MNT) are caused by unhygienic methods of delivery, abortion, or umbilical-cord care. Maternal and neonatal tetanus are both forms of generalized tetanus and have similar clinical courses. About 90% of neonates with tetanus develop symptoms in the first 3-14 d of life, mostly on days 6-8, distinguishing neonatal tetanus from other causes of neonatal mortality which typically occur during the first two days of life. Overall case fatality rates for patients admitted to the hospital with neonatal tetanus in developing countries are 8-50%, while the fatality rate can be as high as 100% without hospital care. Tetanus toxoid (TT) vaccination of pregnant women to prevent neonatal tetanus was included in WHO's Expanded Program on Immunization (EPI) a few years after its inception in 1974. In 2000, WHO, UNICEF, and UNFPA formed a partnership to relaunch efforts toward this goal, adding the elimination of maternal tetanus as a program objective, and setting a new target date of 2005. By February 2007, 40 countries had implemented tetanus vaccination campaigns in high-risk areas, targeting more than 94 million women, and protecting more than 70 million subjects with at least two doses of TT. In 2011, 653 NT cases were reported in India compared with 9313 in 1990. As of February 2012, 25 countries and 15 States and Union Territories of India, all of Ethiopia except Somaliland, and almost 29 of 34 provinces in Indonesia have been validated to have eliminated MNT.