Current Issue : January - March Volume : 2014 Issue Number : 1 Articles : 7 Articles
Background: Resuscitation with bag and mask is a high-impact intervention that can reduce neonatal deaths in\r\nresource-poor countries. This study assessed the capacity to perform newborn resuscitation at facilities offering\r\ncomprehensive emergency obstetric and newborn care (EmONC) in Afghanistan, as well as individual and facility\r\ncharacteristics associated with providers� knowledge and clinical skills.\r\nMethods: Assessors interviewed 82 doctors and 142 midwives at 78 facilities on their knowledge of newborn\r\nresuscitation and observed them perform the procedure on an anatomical model. Supplies, equipment, and\r\ninfrastructure were assessed at each facility. Descriptive statistics and simple and multivariate regression analyses\r\nwere performed using STATA 11.2 and SAS 9.1.3.\r\nResults: Over 90% of facilities had essential equipment for newborn resuscitation, including a mucus extractor, bag,\r\nand mask. More than 80% of providers had been trained on newborn resuscitation, but midwives were more likely\r\nthan doctors to receive such training as part of pre-service education (59% and 35%, respectively, p < 0.001). No\r\nsignificant differences were found between doctors and midwives on knowledge, clinical skills, or confidence in\r\nperforming newborn resuscitation. Doctors and midwives scored 71% and 66%, respectively, on knowledge\r\nquestions and 66% and 71% on the skills assessment; 75% of doctors and 83% of midwives felt very confident in\r\ntheir ability to perform newborn resuscitation. Training was associated with greater knowledge (p < 0.001) and\r\nclinical skills (p < 0.05) in a multivariable model that adjusted for facility type, provider type, and years of experience\r\noffering EmONC services.\r\nConclusions: Lack of equipment and training do not pose major barriers to newborn resuscitation in Afghanistan,\r\nbut providers� knowledge and skills need strengthening in some areas. Midwives proved to be as capable as\r\ndoctors of performing newborn resuscitation, which validates the major investment made in midwifery education.\r\nCompetency-based pre-service and in-service training, complemented by supportive supervision, is an effective way\r\nto build providers� capacity to perform newborn resuscitation. This kind of training could also help skilled birth\r\nattendants based in the community, at private clinics, or at primary care facilities save the lives of newborns....
Background: Severe dehydration is generally believed to be a cause of significant hyperbilirubinemia in newborn\r\nbabies. This study aimed to analyze the weight loss of healthy term newborn infants at 24, 48 and 72 hours after\r\nbirth to predict significant hyperbilirubinemia at 72 hours.\r\nMethods: From January 2007 to December 2008, we conducted this retrospective chart review by measuring total\r\nbilirubin (transcutaneous and serum) in 343 healthy, term newborns with a birth body weight of more than 2500 g. We\r\nthen analyzed the association between body weight loss (BWL) and significant hyperbilirubinemia (total bilirubin more\r\nthan 15 mg/dL) 72 hours after birth. Receiver operating characteristic curves were used to evaluate the appropriate cutoff\r\nBWL percentages on the first three days after birth for the prediction of neonatal hyperbilirubinemia 72 hours after birth.\r\nResults: A total of 115 (33.5%) neonates presented with significant hyperbilirubinemia 72 hours after birth, and the\r\npercentages of BWL on the first three days were all higher than those in the non-significant hyperbilirubinemia group\r\n(all p < 0.05). Breastfeeding was not statistically correlated with significant hyperbilirubinemia (p=0.86). To predict\r\nsignificant hyperbilirubinemia 72 hours after birth, receiver operating characteristic curve analysis showed that the\r\noptimum cutoff BWL percentages were 4.48% on the first day of life (sensitivity: 43%, specificity: 70%, positive likelihood\r\nratio [LR+]: 1.43, and negative likelihood ratio [LR-]: 0.82), 7.60% on day 2 (sensitivity: 47%, specificity: 74%, LR+: 1.81,\r\nLR-: 0.72), and 8.15% on day 3 (sensitivity: 57%, specificity: 70%, LR+: 1.92, LR-: 0.61) (all p < 0.05).\r\nConclusions: BWL on the first three days after birth may be a predisposing factor for neonatal hyperbilirubinemia, and\r\nmay also serve as a helpful clinical factor to prevent significant hyperbilirubinemia 72 hours after birth. The optimal BWL\r\ncutoff percentages on the first three days after birth presented in this study may predict hyperbilirubinemia and\r\nindicate the need for supplementary feeding....
This study is aimed to find out the incidence of preterm birth and its consequences, besides to assess the aetiology and risk factors of preterm birth. A prospective observational study was performed in Neonatal department, Rajiv Gandhi Medical Sciences, Kadapa over 6-months. All the patients were screened to determine the preterm births and their guardians were interviewed to find consequences of it (if any) and factors which leads to them. The incidence of preterm birth is 13%. The most observed risk factors for preterm births were short interval between consecutive pregnancies 30.8% and poor maternal nutrition 25.6%. About 20 (21.3%) were born before 37 weeks, followed by nine (9.6%) were born before 31 weeks. Around 37.2% of preterm births were due to spontaneous preterm pre-labor and rupture of membranes, followed by 28.7% intra uterine growth retardation as etiological factors for preterm birth. About 28.7% preterm neonates develop sepsis followed by 27.6% neonatal seizures. Forecasting and preventing preterm labour and selecting the safest method of delivery are imperative challenges in reducing the incidence of preterm births. Continued research needed to identify interventions that will reduce its incidence....
Background: Differences between urban and rural settings can be seen as a very important example of gaps\r\nbetween groups in a population. The aim of this paper is to compare an urban and a rural area regarding child\r\ngrowth during the first two years of life as related to mother�s use of antenatal care (ANC), breastfeeding and\r\nreported symptoms of illness.\r\nMethods: The studies were conducted in two Health and Demographic Surveillance Sites, one rural and one urban\r\nin Hanoi, Vietnam.\r\nResults: We found that children in the urban area grow faster than those in the rural area. There were statistical\r\nassociations between growth and the education of the mother as well as household resources. There were positive\r\ncorrelations between the number of ANC visits and child growth. We also saw a positive association between\r\ngrowth and early initiation (first hour of life) of breastfeeding but the reported duration of exclusive breastfeeding\r\nwas not statistically significantly related to growth. Reporting symptoms of illness was negatively correlated to\r\ngrowth, i.e. morbidity is hampering growth.\r\nConclusions: All predictors of growth discussed in this article, ANC, breastfeeding and illness, are associated with\r\nsocial and economic conditions. To improve and maintain good conditions for child growth it is important to\r\nstrengthen education of mothers and household resources particularly in the rural areas. Globalization and\r\nurbanization means obvious risks for increasing gaps not least between urban and rural areas. Improvement of the\r\nquality of programs for antenatal care, breastfeeding and integrated management of childhood illness are also\r\nneeded in Vietnam....
unsuccessful. Of current concern is a report by the Tasmanian Law Reform Institute (TLRI) recommending that\r\nnon-therapeutic circumcision be prohibited, with parents and doctors risking criminal sanctions except where the\r\nparents have strong religious and ethnic ties to circumcision. The acceptance of this recommendation would create\r\na precedent for legislation elsewhere in the world, thereby posing a threat to pediatric practice, parental\r\nresponsibilities and freedoms, and public health.\r\nDiscussion: The TLRI report ignores the scientific consensus within medical literature about circumcision. It\r\ncontains legal and ethical arguments that are seriously flawed. Dispassionate ethical arguments and the United\r\nNations Convention on the Rights of the Child are consistent with parents being permitted to authorize\r\ncircumcision for their male child. Uncritical acceptance of the TLRI report�s recommendations would strengthen and\r\nlegitimize efforts to ban childhood male circumcision not just in Australia, but in other countries as well. The\r\nmedical profession should be concerned about any attempt to criminalize a well-accepted and evidence-based\r\nmedical procedure. The recommendations are illogical, pose potential dangers and seem unworkable in practice.\r\nThere is no explanation of how the State could impose criminal charges against doctors and parents, nor of how\r\nsuch a punitive apparatus could be structured, nor how strength of ethnic or religious ties could be determined.\r\nThe proposal could easily be used inappropriately, and discriminates against parents not tied to the religions\r\nspecified. With time, religious exemptions could subsequently be overturned. The law, governments and the\r\nmedical profession should reject the TLRI recommendations, especially since the recent affirmative infant male\r\ncircumcision policy statement by the American Academy of Pediatrics attests to the significant individual and\r\npublic health benefits and low risk of infant male circumcision.\r\nSummary: Doctors should be allowed to perform medical procedures based on sound evidence of effectiveness\r\nand safety with guaranteed protection. Parents should be free to act in the best interests of the health of their\r\ninfant son by having him circumcised should they choose....
Background: Fetal alcohol spectrum disorders (FASD) are underdiagnosed in Australia, and health professionals\r\nhave endorsed the need for national guidelines for diagnosis. The aim of this study was to develop consensus\r\nrecommendations for the diagnosis of FASD in Australia.\r\nMethods: A panel of 13 health professionals, researchers, and consumer and community representatives with relevant\r\nexpertise attended a 2-day consensus development workshop to review evidence on the screening and diagnosis of\r\nFASD obtained from a systematic literature review, a national survey of health professionals and community group\r\ndiscussions. The nominal group technique and facilitated discussion were used to review the evidence on screening\r\nand diagnosis, and to develop consensus recommendations for the diagnosis of FASD in Australia.\r\nResults: The use of population-based screening for FASD was not recommended. However, there was consensus\r\nsupport for the development of standard criteria for referral for specialist diagnostic assessment. Participants developed\r\nconsensus recommendations for diagnostic categories, criteria and assessment methods, based on the adaption of\r\nelements from both the University of Washington 4-Digit Diagnostic Code and the Canadian guidelines for FASD\r\ndiagnosis. Panel members also recommended the development of resources to: facilitate consistency in referral and\r\ndiagnostic practices, including comprehensive clinical guidelines and assessment instruments; and to support\r\nindividuals undergoing assessment and their parents or carers.\r\nConclusions: These consensus recommendations provide a foundation for the development of guidelines and\r\nother resources to promote consistency in the diagnosis of FASD in Australia. Guidelines for diagnosis will require\r\nreview and evaluation in the Australian context prior to national implementation as well as periodic review to\r\nincorporate new knowledge....
Background: A comparative study was performed to compare quality of life after laparoscopic and open\r\nappendectomy in children and adolescents in a German General Hospital. The same study population was\r\nre-evaluated regarding their quality of life several years after operation.\r\nMethods: Children and adolescents (n = 158) who underwent appendectomy for acute appendicitis between 1999\r\nand 2001 were retrospectively analysed. Seven years after surgery those patients were interviewed applying a SF-36\r\nquestionnaire regarding their quality of life.\r\nResults: For short term outcomes there was a trend towards reduced specific postoperative complications in the\r\nlaparoscopically operated group (9.3 vs. 10.7%). Significantly more patients in the laparoscopic group would\r\nrecommend the operation procedure to family members or friends than in the open group. Among the evaluated\r\npatients there was a significantly higher satisfaction concerning size and appearance of their scars in the\r\nlaparoscopic group. The results of the evaluation in the eight categories of the SF-36 showed similar results in both\r\ngroups.\r\nConclusions: More patients with laparoscopic appendectomy appeared to be satisfied with their operation method\r\nas becomes evident by a higher recommendation rate and a higher satisfaction concerning their scars....
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