Neonatal Morbidity and Mortality at Hospital Saint Camille de Ouagadougou (HOSCO): A Study from 2017 to 2020

Introduction: Neonatal pathology remains a real public health problem in developing countries. In Burkina Faso, this mortality has declined over the last ten years but remains below compared to the Sustainable Development Goals, which is 12 per 1000 living births at most by 2030. This study aims to identify specific causes of neonatal morbidity and mortality and will contribute to the implementation of preventive and curative measures aimed at reducing neonatal mortality at HOSCO. Method: This was a retrospective study using the records and database of newborns hospitalized from January 1srt, 2017 to December 31srt, 2020. Using logistic regression, the factors associated with mortality were determined. Results: During the study period, 3020 newborns were hospitalized. Most newborns (83.71%) were referred by a peripheral health facility. The average age at admission was 0.3 days ± 0.9 and the sex ratio was 1.2. Prematurity was the leading cause of hospitalization (61.13%) followed by neonatal infection (38.34%) and neonatal suffering (23.88%). The mortality rate was 40.6% with 82.71% cases of death in the early neonatal period. The main causes of death were low birth weight (47.39%), respiratory distress (18.76%), neonatal suffering (17.37%) and neonatal infection (13.87%). Home delivery, gestational age 36 weeks, number of PNC 4, concept of resuscitation, Apgar at the 5th minute 7, birth weight 2000 g and >4000 g, respiratory distress, hypothermia, neurological disorders were factors associated with deaths. Conclusion: Neonatal mortality is influenced by both maternal and fetal factors and many of them are preventable.

Production and stability study of a hospital parenteral nutrition solution for neonates

Standard parenteral nutrition solutions are mixtures comprising interacting components that may degrade themselves over time. The objective of this study was to investigate the physicochemical and microbiological stability of a hospital preparation for parenteral nutrition in neonatology. The analyses were performed throughout the storage of the preparations at 2–8 °C(up to 4 months). The extent of stability was based on the determination of amino acids dosage, visual and physicochemical properties(glucose and electrolytes concentrations, pH and osmolality measurements, particle counting) and microbiological analysis(sterility test). A thermal degradation of ascorbic acid was conducted to evaluate the antioxidant properties of the parenteral mixture. Physicochemical and microbiological controls were found to comply with the specifications. Amino acids showed a good stability throughout the 4 months storage except for cysteine, which was progressively degraded to cystine, conferring a yellow coloration to parenteral solutions. Parenteral nutrition standards solutions remain stable for 4 months at 2–8 °C,ensuring safe administration in preterm infants.

Preventative Strategies in the Management of ROP: A Review of Literature

Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants weighing 1250 grams or less that are born before 31 weeks of gestation. It is one of the most common causes of visual loss in childhood and can lead to lifelong vision impairment and blindness. Certain strategies for prevention have been confirmed by numerous trials, namely the role of oxygen therapy as an independent risk factor for the development of ROP and the benefits of strict control of premature infant oxygen saturations in the NICU. There is valuable data that supports use of other approaches, such as beta adrenergic blockade and IGF-1 supplementation, for which clinical trials are still in the works to establish clear protocols for their clinical use. Supplementation with vitamin A, omega-3 fatty acids, and inositol are all exciting arenas for further trials as preliminary data shows promising results in ROP prevention. It has also been shown that the benefit of vitamin E is not worth the increased incidence of NEC and sepsis as potential side effects. Furthermore, while it was an interesting idea to use the chelator D-penicillamine as a preventative strategy for ROP, the results of multiple trials seemed to be equivocal. This brief review is not all-inclusive, as there are many more modes of prevention currently being studied.

Factors Associated with Umbilical Cord Stump Healing Practices: Literature Review

Objective: To analyze the evidence in the evolution of scientific production on the factors associated with curative practices of the umbilical stump. Materials and Methods: The study data collection took place in April 2017. The electronic databases used to search the articles were: PubMed (National Library of Medicine and National Institutes of Health) and VHL (Virtual Health Library). We used the keywords “perinatal care”, “umbilical cord”, “patient care team”, “neonatology”, “newborn”, in the Portuguese, English and Spanish languages, accompanied by the expression AND and selected through DeCS (Descriptors in Health Sciences). Results: A final sample of 9 articles was obtained from the PubMed and VHL databases, which met the inclusions criteria. It has been found that traditional umbilical stump care practices are still present in many communities, however, have been replaced by appropriate practices, the most recommended being: chlorhexidine 4% sanitation, soap and water and alcohol antisepsis 70%. Conclusions: There is a need for multi-professional involvement, approaching these women since pregnancy, with detailed information and accessible language about proper care with the newborn and the umbilical stump.

Intracranial Hemorrhage in Newborn with TAR Syndrome—A Feared Complication

The thrombocytopenia-absent radius (TAR) syndrome is an autosomal recessive disease characterized by bilateral absence of radius with the presence of both thumbs and thrombocytopenia, many times associated with cardiac anomalies, intolerance or allergy to cow’s milk and phocomelia. Imaging study is important for the correct diagnosis at birth and documentation of one of the diagnosis criteria (absence of radius) in prenatal care. The main hematologic symptoms and the most feared of them, intracranial bleeding, occurs when platelets levels are below 10,000/mm3, which is more common during the first months. Therefore, imaging study is crucial to quickly identify complications and correctly manage the case. In this case report, the patient had upper limps alterations at birth and at first week presented seizures, with transfontanellar ultrasound and head computed tomography without contrast demonstrating intracranial hemorrhage. Laboratory results and imaging review were able to diagnose TAR syndrome. The patient was treated with platelets transfusion and thrombocytopenia was solved. She is currently under specialized medical care, with no neurological deficits and showing satisfactory development.

Neonatal Bacterial Infections in Parakou in 2013

Objective: Neonatal bacterial infections are a leading cause of mortality in developing countries, including Benin. This study aimed to investigate the epidemiological, clinical and bacteriological aspects of neonatal bacterial infections and their outcomes in the neonatal care unit of the Borgou Regional University Teaching Hospital (CHUD-Borgou). Study design: This manuscript described a cross-sectional study with prospective data collection and an analytical purpose that was performed over the course of 3 months. It was conducted in the neonatal care unit of CHUD-Borgou and focused on 203 newborns who were admitted for suspected bacterial infection. Results: Neonatal bacterial infections accounted for 63.75% of admissions. The sex ratio was 1:1. Prematurity was the main reason for admission (25.1%), and respiratory distress was the most common physical symptom (22.2%). From a bacteriological point of view, 14.7% of blood cultures were positive, and the main isolated pathogens were Escherichia coli (35.8%), Staphylococcus aureus (21.5%) and Klebsiella pneumoniae (14.3%). These pathogens were more sensitive to aminoglycosides than to other antibiotics. Lethality was 21.6%. Place of birth (p < 10-3), age of the newborn at admission (p = 0.003) and maternal history of infectious diseases during pregnancy (p = 0.02) were factors associated with neonatal bacterial infections. Conclusion: This study identified the main pathogens responsible for neonatal bacterial infections and their level of sensitivity to antibiotics. It also determined the different factors associated with neonatal bacterial infections that should be considered in newborn care.

Evaluation of a complex couplet care intervention in a neonatal intensive care unit:A mixed methods study protocol

Background:Families with an infant in need of intensive care most often experience a harmful separation after birth.This is due to a division of medical specialties into neonatal care and maternal care.Therefore,a couplet care intervention is implemented for mother-infant dyads in a neonatal intensive care unit.This study protocol provides a comprehensive evaluation of the intervention.The aim is to evaluate the effect and implementation of a complex couplet care intervention to promote zero separation between mother and infant.Methods:The couplet care intervention is a family-centered model of care,where treatment-requiring mother-infant dyads will be admitted together and receive couplet care by neonatal nurses.The study adheres to the framework of the Medical Research Council and will use a mixed methods embedded design comprising a quasi-experimental trial and a qualitative process evaluation.Finally,a health economic evaluation will be conducted to assess the cost-effectiveness of this complex couplet care intervention.Discussion:Separation of mother-infant dyads after birth has an adverse impact on family health and well-being.This study protocol evaluates a complex couplet care intervention.With this study,a first step is taken to help bridge the gap between current practices and a new care model to prevent the separation of mothers and their infants.

Early term infants are at increased risk of requiring neonatal intensive care

Background: Increasing evidence is demonstrating thatinfants born early on during the term period are at increasedrisk of morbidity compared with infants born closer to acomplete 40 week gestational pregnancy. The purpose of thisstudy was to compare early term [gestation age (GA): 37-376/7 weeks] neonatal outcomes with those of other full termneonatal intensive care unit (NICU) admissions.Methods: Retrospective chart review of all term infantsadmitted to the NICU at New York University LangoneMedical Center over a 17 month period. Subjects weregrouped and analyzed according to their GA at birth: 1)early term infants (GA between 37 0/7 to 37 6/7 weeks) and2) other term infants (38 0/7 weeks and older).Results: Early term infants were more likely to requireNICU care than other term infants [relative risk: 1.42,95% confidence interval (CI)=1.07-1.88), P=0.01]. In theNICU, they are more likely to manifest respiratory distresssyndrome [odds ratio (OR)=5.7, 95% CI=1.6-19.8, P<0.01]and hypoglycemia (OR=4.6, 95% CI=2.0-10.4, P<0.001).In addition, early term neonates were more likely to beborn via elective cesarean section than other term neonates(OR=4.1, 95% CI=2.0-8.5, P<0.001).Conclusions: Being born at early term is associatedwith increased risk of respiratory disease and hypoglycemiarequiring neonatal intensive care. Further efforts directedat decreasing early term deliveries may be warranted.