Advances in Neonatology

Introduction: Skin-to-skin contact (CPP) is the placement of the naked newborn on the mother’sbreast, covered only with a cap, sheet or gown.Objective: To determine the effect of skin-to-skin contact in the breastfeeding of infants in theNational Institute of Perinatology.Material and methods: Prospective, descriptive, observational, and cross-sectional study wasperformed, including a search for the information in the database of the Immediate Care Unitfor the Newborn from 1 August 2015 to 31 July 2016. The data obtained were Gestational age,weight, Apgar, maternal pathology, skin-to-skin contact, duration, and feeding.Results: There were 3175 births, with 2228 term neonates. CPP was performed in 1486 neona-tes (78.95%), with a weight of 2,045 to 4,200 g. The majority of patients who were breastfed(78.7%) had had skin-to-skin contact. Likewise, it was observed that CPP significantly favouredbreastfeeding (RR=143.28; 95% CI: 75.5-271.7).Discussion: CPP favours breastfeeding (99.2%), making the first food human milk, and reducingthe use of substitutes.Conclusions: Skin-to-skin contact is the best opportunity for the initiation of breastfeeding.The separation of mothers and their children at birth has become a common practice in thedelivery and operating rooms, due to hospital routines, placing the infant in a cradle of radiantheat, and initiating breastfeeding after one hour of life.

INTRODUCCIÓN: La disponibilidad y comercialización de la inmunoglobulina G humana ha modificado el curso y pronóstico de diversas enfermedades. Hoy en día representa el tratamiento de primera línea para al menos 10 enfermedades y de segunda línea, empírico o de indicación compasiva en otras alteraciones. La mayor parte de estas enfermedades son excepcionales (afectan a menos de 1 de cada 2000 individuos), por lo que la generación de evidencia robusta derivada de ensayos clínicos aleatorizados y controlados no es común.



OBJETIVO: desarrollar Elaborar o Emitir un Consenso Mexicano para la prescripción de Inmunoglobulina G Humana como tratamiento de reemplazo e inmunomodulación con un enfoque de medicina basada en evidencias.




MATERIALES Y MÉTODOS: Se integró un grupo multidisciplinario de especialistas en diversas áreas de la medicina en México, con la finalidad de emitir un análisis crítico y sistematizado de la evidencia clínica disponible para la prescripción de la inmunoglobulina G humana. Se revisaron las bases de datos MEDLINE, EMBASE, BVS-LILACS, NGS, NICE, CENETEC, Imbiomed, TripDatabase y Medigraphic. Para el análisis de la información se utilizaron algoritmos con términos Medical Subject Headings (MeSH) o Descriptores en Ciencias de la Salud (DeCS) específicos para cada enfermedad, con la intención de identificar guías de práctica clínica u otro tipo de guías, revisiones sistemáticas, metanálisis, ensayos clínicos aleatorizados, estudios clínicos, estudios descriptivos u observacionales y análisis de costobeneficio. Para el estudio de la evidencia se organizaron ocho grupos de trabajo, de acuerdo con el campo de conocimiento y la experiencia de los especialistas. Se formularon preguntas clínicas con el constructo PICO, por su acrónimo en inglés: Patients (pacientes o población),  Intervention (intervención de interés), Comparison (comparación con otra intervención) y Outcome (desenlace de interés). Después de discutir las evidencias correspondientes y responder las preguntas, se redactó un documento con declaraciones específicas por indicación y calidad de evidencia con el esquema GRADE. Las declaraciones fueron sometidas a evaluación y consenso por todo el grupo de trabajo y se elaboró un documento con el formato actual para validación externa por los principales representantes de las academias y los colegios de las áreas del conocimiento incluidas, para finalmente publicarlo como tratamiento de referencia en la prescripción de la inmunoglobulina G humana en México.



CONCLUSIONES: La integración del consenso representa un esfuerzo en aras de proporcionar a los clínicos de instituciones de segundo y tercer nivel de atención en salud de México. Además de proporciona un instrumento validado para la prescripción correcta de inmunoglobulina G humana como tratamiento de reemplazo e inmunomodulación. Este documento debe actualizarse de manera continua, debido al activo campo de investigación clínica en diferentes aplicaciones de la medicina.

Through 2005 a new simulation pediatric centre linked to
the Faculty of Medical Sciences (The New University of Lisbon) became effective at Dona Estefânia Hospital,
Lisbon. The main innovation was concerned with the
opportunities of simu lation procedures practice devoted to
the 5 th year medical students using manikins. This study
aimed to describe the functioning of the mentioned learning
– teaching setting and to assess the feedback and suggestions from the trainees and trainers as a keystone of future
planning.
All the trainees regarded this training model as very relevant
for their apprenticeship as a complement of clinical practice
with real patients. Most of them expressed the need for high
amounts of time available for the training and for more diversity of manikins. According to the trainers experiences there
is a need to improve some logistic issues and to maximize the
facilities opening this setting to the post-graduation trainees
whose implications are to improve the protocol rules between
the faculty and the hospital.
In summary, we recognize the limitations to this study regar ding the findings drawn from the qualitative and subjective
collected data delivered by medical students and from
expertise of trainers. However, this survey, which may be
consi dered as an internal audit, suggests the need for
changes in the curriculum and for improvement of essential
logistic issues.
Key-words: medical undergraduation, post-graduation residency, continuing medical education, skills teaching-learning, simulation centre, technical procedures

RESUMEN El presente trabajo se desarrolla en el marco de un proceso de incorporar un abordaje psicoterapéutico en un Hospital Materno Infantil, la estrategia con que ingresamos fue realizando atenciones demostrativas, a partir de las cuales, buscábamos que los diferentes profesionales puedan percibir la necesidad y trascendencia de brindar apoyo psicológico a las familias de recién nacidos en riesgo. Presentamos una de estas intervenciones para a partir de ella generar algunas reflexiones en torno a la utilidad de estas intervenciones en tres niveles, para la familia, para su incorporación entre las atenciones que brinda Hospital y al equipo de Tejiendo Lazos. Palabras clave: Psicología perinatal, recién nacido en riesgo, trabajo de duelo

Background: ENSTN is the first database to collect incidents and medical errors in NICU in Egypt. To ensure confidential and anonymous reporting system, identify the nature of medical errors and grade of harm as well as the risk factors. To promote patient safety culture and aid to decrease mortality and morbidity due to medical errors in NICU. Methods: Data reported by one University hospital and 12 non-University hospitals were collected through internet-based system on our webpage. Incident reporting icon in English and Arabic languages with standard structured data entry format was developed during the ENSTN project life time (www.egyneosafety.net).The system provides confidential and anonymous reporting. The number and types of reported events and factors that contributed to the events were verified and validated. Results: In total, 2724 incidents were verified. The majority of incidents were from the English versions 2699 while Arabic version 25 incidents. English first version 866 incidents, second 155 and third final versions 1678 incidents. The most frequent events categories were equipment/ devices in 29.94%, and treatment/medication errors in 29.68%. Incident classification showed that 43.20% of incidents were adverse events, 5.928% were sentinel, 50.166% near miss and 0. 222% intentionally unsafe act, while 0.481% of incidents were not determined by reporters. The most frequent contributory factors were related to medication errors (28.34%), education/training (28.26%), and communication problems (27.82%). Serious patient harm was reported in 2.945%, death in 4.528% and minor harm in 25.259% of reported incidents. Conclusions: The ENSTN incidents reporting system successfully demonstrated the most common types and causes of medical errors in NICUs and underlying contributing factors. These findings suggest need multidisciplinary collaborative training. The ENSTN educational forum may play a role in reducing medical errors.

Background: Misuse of antibiotics in the treatment of URTI among children is becoming a major contributor to the emergence of antibiotic resistance that is becoming a major public health problem worldwide. Mothers must be equipped with essential knowledge and skills about proper antibiotics use for their children with URTIS to avoid antibiotic resistance. Aim: The aim of this study was to assess maternal knowledge and treatment practices regarding the use of antibiotics among their children with URTIS. Method: A cross-sectional descriptive design was conducted on a convenience sample of 100 mothers throughout 3 months who attending the General Outpatient Clinics number 4 and 5 and inpatient Cardiology and Medical departments at Mansoura University Children Hospital (MUCH). Data was collected by using a structured interview questionnaire sheet that consisted of three parts; characteristics of the studied mothers and their children, mothers' knowledge about antibiotics and mothers' practices regarding the use of antibiotics for their children with URTI. Results: More than half of the studied mothers (64.0%) had poor knowledge about antibiotics and the majority of them (84.0%) had satisfactory practices regarding use of antibiotics for their children with URTI. A relationship was founded between mothers' knowledge and their residence, educational level and occupation with statistical significance (p≤0.05). Also; a relationship was founded between the studied mothers' practices regarding giving antibiotic suspension for their children with URTI and their educational level with statistical significance (p≤0.019). Conclusion: it is concluded that more than half of the studied mothers had poor knowledge about antibiotics and the majority of them had satisfactory practices. Also, the studied mothers' knowledge is affected by their residence, educational level and occupation. As well as, the studied mothers' practices are affected only by their educational level. Recommendation: it is recommended to implement health educational program for mothers about antibiotic use to improve their knowledge and practices towards the safe use of antibiotics for their children with URTI.

CONTEXT: The eutectic mixture of lidocaine (EMLA) cream has been used to reduce the pain during venipuncture in infants.
abstract
OBJECTIVE: To determine the efficacy and safety of EMLA in infants <3 months of age requiring venipuncture in comparison with nonpharmacological interventions in terms of pain reduction, change in physiologic variables, and methemoglobinemia.
DATA SOURCES: Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and gray literature were searched from inception to August 2017, without language restrictions.
STUDY SELECTION: We selected randomized controlled trials in which researchers compared EMLA with nonpharmacological interventions.
DATA EXTRACTION: Two reviewers independently performed abstract screening and full-text review, and extracted the data and assessed the risk of bias.
RESULTS: Ten randomized controlled trials (907 infants) were included. EMLA revealed little or no effect in reduction of pain (standardized mean difference: 0.14; 95% confidence interval [CI]: −0.17 to 0.45; 6 trials, n = 742; moderate-quality evidence) when EMLA was compared with sucrose, breastfeeding, or placebo. In comparison with placebo, EMLA revealed a small-to-moderate effect on increasing methemoglobin levels (mean difference: 0.35; 95% CI: 0.04 to 0.66; 2 trials, n = 134; low-quality evidence). There was an increased risk of blanching of the skin in the EMLA group (relative risk: 2.63; 95% CI: 1.58 to 4.38; 2 trials, n = 123; I2 = 84%, very low–quality evidence).
LIMITATIONS: Our results may not be applicable to older infants.
CONCLUSIONS: EMLA reveals minimal benefits in terms of reduction of pain due to venipuncture procedure in comparison with placebo and no benefit in comparison with sucrose and/or breastfeeding. Moreover, it produced an elevation in methemoglobin levels and skin blanching.

ntroducción: Los prematuros pueden presentar lesiones por reperfusión hiperóxica, por lo quese deben evitar niveles nocivos de oxígeno.Objetivo: Determinar, durante la reanimación neonatal de recién nacidos de 27 a 30 semanasde edad gestacional, los requerimientos de oxígeno, el porcentaje de saturación y su relacióncon la morbilidad neonatal.Material y métodos: Estudio transversal observacional y analítico. Se incluyeron neonatos de27 a 30 semanas de gestación; se excluyeron neonatos con malformaciones congénitas mayoresy las defunciones antes de las 36 semanas de edad gestacional corregida. Se dividieron en grupo1, neonatos de 27 y 28 semanas, y grupo 2, neonatos de 29 y 30 semanas; se analizaron variablesmaternas y neonatales con requerimiento de FiO2y saturación de oxígeno a los 5 y 10 minutos,así como el desarrollo de morbilidad neonatal.Resultados: Ingresaron 39 neonatos en el grupo 1 y 31 en el grupo 2. La FiO2en promediopara el grupo 1 a los 5 minutos fue del 77.56%, y para el grupo 2, del 64.9% (p = 0.045). Elgrupo 1 necesitó mayor concentración de oxígeno para alcanzar saturaciones > 80%. Hubo unaumento de riesgo para hemorragia intraventricular (OR 3.21; IC95%: 1.07-9.60) en el grupo 1.La morbilidad no tuvo relación con la saturación de oxígeno durante la reanimación neonatal

Abstract: Despite efforts to decrease unnecessary use of antibiotics, misconceptions about antibiotics use persist
and continue to be more prevalent among mothers of children with URTIs. Aim: This study aimed to study the
effectiveness of learning package application on the use of antibiotics for mothers of children with URTIs. Method:
A quasi-experimental design was conducted on 214 mothers with their children regardless their gender, age, free
from chronic diseases, diagnosed with URTIs and managed by antibiotics, who attended the General Outpatient
Clinics at Mansoura University Children's Hospital (MUCH). Tools: A structured interview questionnaire sheet
for mothers' knowledge and practical knowledge, observational checklist for mothers' practices about
administration of antibiotic suspension and learning package evaluation checklist. Results indicated that, the
majority of the studied mothers had good knowledge (85.5%) and most of them (98.6%) had competent practices
immediately post the learning package application with highly statistical significant differences (p=0.00).
Conclusion: There was an improvement in mothers' knowledge, practical knowledge and practices after
application of learning package. Recommendations: Provide in-services, up to date and regular training programs
to improve mothers' knowledge and practices regarding the use of antibiotics for their children with URTIs.
Further studies are recommended to repeat this study on a larger sample size and on a wide scale in various
governorates of Egypt.
Keywords: Antibiotics, Bacterial resistance, Children, Knowledge, Learning package, Mothers, Practices and
Upper respiratory infections.

Background The incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-income countries. In order to reduce the incidence of the disease, a protocol on preventing, screening and treating ROP was published in Indonesia in 2010. To assist the practical implementation of the protocol, meetings were held in all Indonesia regions, calling attention to the high incidence of ROP and the methods to reduce it. In addition, national health insurance was introduced in 2014, making ROP screening and treatment accessible to more infants. Objective To evaluate whether the introduction of both the guideline drawing attention to the high incidence of ROP and national health insurance may have influenced the incidence of the disease in Indonesia. Setting Data were collected from 34 hospitals with different levels of care: national referral centres, universitybased hospitals, and public and private hospitals. Methods A survey was administered with questions on admission numbers, mortality rates, ROP incidence, and its stages for 2016-2017 in relation to gestational age and birth weight. Results We identified 12 115 eligible infants with a gestational age of less than 34 weeks. Mortality was 24% and any stage ROP 6.7%. The mortality in infants aged less than 28 weeks was 67%, the incidence of all-stage ROP 18% and severe ROP 4%. In the group aged 28-32 weeks, the mortality was 24%, all-stage ROP 7% and severe ROP 4%-5%. Both mortality and the incidence of ROP were highest in university-based hospitals. Conclusions In the 2016-2017 period, the infant mortality rate before 32 weeks of age was higher in Indonesia than in high-income countries, but the incidence of ROP was comparable. This incidence is likely an underestimation due to the high mortality rate. The ROP incidence in 2016-2017 is lower than in surveys conducted before 2015. This decline is likely due to a higher practitioner awareness about ROP and national health insurance implementation in Indonesia. HKWCHC, Harapan Kita Women and Children's Hospital (National Centre for Women and Children's Health); OH, other hospitals; ROP, retinopathy of prematurity; RSCM/NRH, Ciptomangunkusumo Hospital (national referral hospital); UBH, university-based hospital.

There is no consensus with regard to which charts are most suitable for monitoring the postnatal growth of preterm infants. We aimed to assess the strategies used to develop existing postnatal growth charts for preterm infants and their methodologic quality. A systematic review of observational longitudinal studies, whose primary objective was to create postnatal growth charts for preterm infants, was conducted. Thirty-eight items distributed in 3 methodologic domains (&quot;study design,&quot; &quot;statistical methods,&quot; and &quot;reporting methods&quot;) were assessed in each study. Each item was scored as a &quot;low&quot; or &quot;high&quot; risk of bias. Two reviewers independently selected the studies, assessed the risk of bias, and extracted data. A total quality score [(number of &quot;low risk&quot; of bias marks/total number of items assessed) × 100%] was calculated for each study. Median (range, IQR) quality scores for each methodologic domain and for all included st...

There is no consensus with regard to which charts are most suitable for monitoring the postnatal growth of preterm infants. We aimed to assess the strategies used to develop existing postnatal growth charts for preterm infants and their methodologic quality. A systematic review of observational longitudinal studies, whose primary objective was to create postnatal growth charts for preterm infants, was conducted. Thirty-eight items distributed in 3 methodologic domains (&quot;study design,&quot; &quot;statistical methods,&quot; and &quot;reporting methods&quot;) were assessed in each study. Each item was scored as a &quot;low&quot; or &quot;high&quot; risk of bias. Two reviewers independently selected the studies, assessed the risk of bias, and extracted data. A total quality score [(number of &quot;low risk&quot; of bias marks/total number of items assessed) × 100%] was calculated for each study. Median (range, IQR) quality scores for each methodologic domain and for all included st...

INTRODUCCIÓN: La disponibilidad y comercialización de la inmunoglobulina G humana ha modificado el curso y pronóstico de diversas enfermedades. Hoy en día representa el tratamiento de primera línea para al menos 10 enfermedades y de segunda línea, empírico o de indicación compasiva en otras alteraciones. La mayor parte de estas enfermedades son excepcionales (afectan a menos de 1 de cada 2000 individuos), por lo que la generación de evidencia robusta derivada de ensayos clínicos aleatorizados y controlados no es común. OBJETIVO: desarrollar Elaborar o Emitir un Consenso Mexicano para la prescripción de Inmunoglobulina G Humana como tratamiento de reemplazo e inmunomodulación con un enfoque de medicina basada en evidencias. MATERIALES Y MÉTODOS: Se integró un grupo multidisciplinario de especialistas en diversas áreas de la medicina en México, con la finalidad de emitir un análisis crítico y sistematizado de la evidencia clínica disponible para la prescripción de la inmunoglobulina G...

Evidence-based practice supports the patient care process by integrating patient values and preferences with clinician expertise and the best available evidence. This approach to patient care focuses on quality and safety with the aim of improving patient outcomes. Despite its obvious value, healthcare professionals struggle to integrate evidence-based best practices into their clinical practice Keywords research implementation, neuroprotective care, neonatal intensive care, evidence-based practice, age-appropriate care

INTRODUCCIÓN: La disponibilidad y comercialización de la inmunoglobulina G humana ha modificado el curso y pronóstico de diversas enfermedades. Hoy en día representa el tratamiento de primera línea para al menos 10 enfermedades y de segunda línea, empírico o de indicación compasiva en otras alteraciones. La mayor parte de estas enfermedades son excepcionales (afectan a menos de 1 de cada 2000 individuos), por lo que la generación de evidencia robusta derivada de ensayos clínicos aleatorizados y controlados no es común. OBJETIVO: desarrollar Elaborar o Emitir un Consenso Mexicano para la prescripción de Inmunoglobulina G Humana como tratamiento de reemplazo e inmunomodulación con un enfoque de medicina basada en evidencias. MATERIALES Y MÉTODOS: Se integró un grupo multidisciplinario de especialistas en diversas áreas de la medicina en México, con la finalidad de emitir un análisis crítico y sistematizado de la evidencia clínica disponible para la prescripción de la inmunoglobulina G...

INTRODUCCIÓN: La disponibilidad y comercialización de la inmunoglobulina G humana ha modificado el curso y pronóstico de diversas enfermedades. Hoy en día representa el tratamiento de primera línea para al menos 10 enfermedades y de segunda línea, empírico o de indicación compasiva en otras alteraciones. La mayor parte de estas enfermedades son excepcionales (afectan a menos de 1 de cada 2000 individuos), por lo que la generación de evidencia robusta derivada de ensayos clínicos aleatorizados y controlados no es común. OBJETIVO: desarrollar Elaborar o Emitir un Consenso Mexicano para la prescripción de Inmunoglobulina G Humana como tratamiento de reemplazo e inmunomodulación con un enfoque de medicina basada en evidencias. MATERIALES Y MÉTODOS: Se integró un grupo multidisciplinario de especialistas en diversas áreas de la medicina en México, con la finalidad de emitir un análisis crítico y sistematizado de la evidencia clínica disponible para la prescripción de la inmunoglobulina G...

INTRODUCCIÓN: La disponibilidad y comercialización de la inmunoglobulina G humana ha modificado el curso y pronóstico de diversas enfermedades. Hoy en día representa el tratamiento de primera línea para al menos 10 enfermedades y de segunda línea, empírico o de indicación compasiva en otras alteraciones. La mayor parte de estas enfermedades son excepcionales (afectan a menos de 1 de cada 2000 individuos), por lo que la generación de evidencia robusta derivada de ensayos clínicos aleatorizados y controlados no es común. OBJETIVO: desarrollar Elaborar o Emitir un Consenso Mexicano para la prescripción de Inmunoglobulina G Humana como tratamiento de reemplazo e inmunomodulación con un enfoque de medicina basada en evidencias. MATERIALES Y MÉTODOS: Se integró un grupo multidisciplinario de especialistas en diversas áreas de la medicina en México, con la finalidad de emitir un análisis crítico y sistematizado de la evidencia clínica disponible para la prescripción de la inmunoglobulina G...

Intraventricular haemorrhage (IVH) is the most frequent neurological complication of the premature infant, and is associated with an adverse neurological outcome. The objective of this study was to identify risk factors associated with IVH in preterm infants less than 1500 g in the NICU.

Material and methods
A cohort of preterm infants less than 1500 g, admitted to the NICU during 2016, were followed up during their hospital stay until their discharge to home, or death. Perinatal and neonatal variables were analysed. For the statistical analysis, those that developed IVH were compared with those that did not, using the chi-squared test, Student's t-test, odds ratio (OR), and mean difference, with a 95% confidence interval.

Results
IVH was present in 45 (33.3%) neonates, out of a total of 135, being grade 1 in 22 (16%), grade 2 in 6 (4.4%), grade 3 in 8 (5.9%), and grade 4 in 9 (6.6%). C-section had a favourable effect on those babies without IVH (OR: 0.18; 95% CI: 0.07-0.45). The mortality was higher in babies with IVH (OR: 4.63; 95% CI: 1.76-12.11). The birth weight and gestational age were less in those with IVH (887 vs 979 g, and 28.1 vs 29.26 GW). The mortality in severe IVH (grade 3+4) was 64.7%, and in grade 1+2 IVH it was 10.7% (P=.0006).

Conclusions
IVH in infants less than <1500 g is a frequent morbidity, especially in those with low gestational age and birth weight. Severe IVH was associated with mortality.

El trabajo trata de dar cuenta de la concepción médica del cuidado de bebés prematuros y la exclusión que ésta ocasiona de las madres de las áreas de neonatología. Por otro lado trata de indagar en la concepción de las madres como receptáculos de una doble contaminación necesaria: el cuerpo y su leche. Es de la propia experiencia de la autora de donde surge el ánimo por este estudio, cantera de material (auto) etnográfico. Atestigua, a través de un trabajo de campo realizado durante tres meses en la ciudad de Santiago de Chile (Chile), la resistencia de las madres de hijos prematuros hospitalizados, tanto en unidades de neonatología pertenecientes a red pública como a red privada, al poder médico, cuya máxima representación se encuentra en la práctica del tráfico de leche materna. La ayuda mutua y la expresión del nacimiento de un grupo resistente se expresan en la donación encubierta de leche.

Background: Neonatal jaundice is a very common condition. Serious unconjugated hyperbilirubinemia may result in neurological dysfunction as catastrophic as kernicterus. Phototherapy is the method of choice in treatment of hyperbilirubinemia. Aim and objectives: the aim of the study was to assess the accuracy of transcutaneous bilirubin measurement during phototherapy by using skin patch and comparing this with skin and serum bilirubin measurement at the same time. Subjects and methods: This was an observational prospective study was conducted in special care baby unit at Al-wahda teaching hospital-Derna-Libya over a period of nine months (June 1 st 2021 to March 2022).Eighty (80) newborn (41 Male, 39 Female) were enrolled in the study .Transcutaneous bilirubin measurement from skin over sternum, skin under patch at Rt. Side of chest, simultaneously serum bilirubin sample were collected. Results: during phototherapy; the mean± SD TSB (14.94 ± 4.57 μmol/L) and mean± SD TCBC (13.52 ± 4.84) and at skin level was 9.45 ± 3.62. Bland-Altman plot showed significant agreement between TcB from patched site and TSB Conclusion: TCB measurements correlate strongly with TSB levels during and after PT. However, as a result of the wide and clinically relevant disagreement between TCB and TSB measurements during the PT phase, a TCB device cannot be recommended for monitoring bilirubin level during PT in our opinion. However, based on our results, we would advocate the use of TCB for TSB 'rebound' measurements at 12 hours after PT to avoid unnecessary serum sampling.

The financial sector, as an administration area and as a component of the monetary framework, plays a crucial role in the presentation of any economy. Banking institutions in our country have been entrusted with a crucial role in financing planned monetary development. Any economy's strength is determined by the effectiveness and severity of its banking framework. The Indian economy is no exception, and the banking system in India plays an important role in the country's monetary development and advancement. The purpose of the study is to assess ICICI Bank and HDFC Bank's financial performance. The investigation's main goals are to look into ICICI Bank and HDFC Bank's monetary displays. The study spans a five-year period, for example, from 2015- 16 to 2019-20. Extent Analysis was used to analyses and consider designs in dealing with a record business and financial execution, such as the Credit Deposit Ratio, Interest Expenses to Total Expenses, Interest Income to Total Income, Other Income to Total Income, Net Profit Margin, Net Worth Ratio, Percentage Change through and through Income, Percentage Change by and large Expenditure, Percentage Change in Deposits, and Percentage Change in Advances. To investigate the examples in setting away cash business usefulness, mean, standard deviation (SD), standard error (SE), coefficient of variance (CV), and compound annual growth rate (CAGR) were utilized.

There is no consensus with regard to which charts are most suitable for monitoring the postnatal growth of preterm infants. We aimed to assess the strategies used to develop existing postnatal growth charts for preterm infants and their methodologic quality. A systematic review of observational longitudinal studies, whose primary objective was to create postnatal growth charts for preterm infants, was conducted. Thirty-eight items distributed in 3 methodologic domains (&quot;study design,&quot; &quot;statistical methods,&quot; and &quot;reporting methods&quot;) were assessed in each study. Each item was scored as a &quot;low&quot; or &quot;high&quot; risk of bias. Two reviewers independently selected the studies, assessed the risk of bias, and extracted data. A total quality score [(number of &quot;low risk&quot; of bias marks/total number of items assessed) × 100%] was calculated for each study. Median (range, IQR) quality scores for each methodologic domain and for all included st...

Introduction: Intracardiac rhabdomyomas cna cause severe ventricular dysfunction and outflow tract obstruction.  Case report: A term newborn infant with antenatal diagnosis of giant left ventricule rhabdomyoma presented with cardiac failure and duct-dependent systemic circulation after birth. She was treated successfully with everolimus, showing decrease in tumour size and improvement in left ventricular ejection fraction. Discussion: tumour regression rate was 0.32 cm2/ day and improved to 0.80cm2/day with the use of everolimus.  Herein we report a newborn with inoperable giant left ventricular cardiac rhabdomyoma and significatn regression of the tumour.  T our knowledge, this is the largest left ventriculoar rhabdomyoma reported.  A review of the literature was undertaken for comparison.  Conclusion Everolimus has proven to be efficacious in size redution of cardiac rhabdomyoma in cases when surgical resection is not possible.

Neonatology is a branch of paediatric nursing that the author has developed a special fondness for during her clinical placement. When on practice, the author was consistently aware that neonates cannot actively verbalise pain. The author often perceived that often it was possible that their pain could be undiagnosed at times. During invasive procedures such as venepuncture, she witnessed “Sweet-Ease” or sucrose solution being used as a form of non-pharmacological pain relief and often queried its efficacy.

Background
We have prospectively studied 220 children attending our Division because they suffered from atopic dermatitis (AD), asthma, and allergic rhinitis
(AR) to assess the epidemiology of atopic diseases, and effectiveness of the diagnostic tests commonly used in allergic children.
Patients and Methods
Among the 220 children there were 142 males (64.5%) and 78 females (35.5%) aged as follows: 57 (25.9%) 0-2 year old, 48 (21.8%) 2-4 year old, 49
(22.3%) 4-6 year old, 66 (30%) >6 year old. The diagnosis included family and personal history, physical examination, skin prick tests (SPT) and total
and specific IgE (sIgE) levels. We tested inhalant and food allergens.
Results
There were 101 asthmatic, 88 with AD, and 31 children with AR. The analysis of variance confirmed the age influence of PRIST with a high significance
(p= 0.0001). SPTs were prevalent in all groups for Der p, but casein only in one group, and Lolium perenne only in two groups. RAST showed a higher
uniformity, that is CM (cow’s milk) and egg for one group, Der p and Lolium perenne for the remaining groups several correlations among diagnostic
tests and the age of children were evaluated with the analysis of variance.
Conclusion
We emphasize that atopic diseases are genetically transmitted, that AD develops at a younger age than asthma (p= 0.0052), and that SPTs have a greater
effectiveness for inhalant allergens, positive at all age levels; in food allergy (FA) SPTs are less adequate and feasible

F x λ = v, Dimensions in Ophthalmology- This was the title of the Jules Francois honor lecture presented at the XXV SIDUO meeting in Berlin 2-6 of July 2014 (Societas Internationalis Ultrasonica pro Diagnostica in Ophthalmologia). The event marked that half a century had passed
since the ultrasonic society’s first meeting in 1964, also held in Berlin.

Focus of the lecture was on the ultrasonically determined dimensions of the eye and the widening of our knowledge regarding optical parameters and their interplay, from fetal stage and on. This includes what happens from intrauterine conditions and past delivery to adult age. Here this is filtered through the mind of the lecturer, who has been active in ultrasound since 1968. The author’s aim has been to specify and discuss some of the stepping stones on the way, outlining a development that has literally extended the dimensions of ophthalmology beyond mere ocular size aspects.

Adrenaline, also known as epinephrine, is a hormone, neurotransmitter, and medication. It is the best established drug in neonatal resuscitation, but only weak evidence supports current recommendations for its use. Furthermore, the available evidence is partly based on extrapolations from adult studies, and this introduces further uncertainty, especially when considering the unique physiological characteristics of newly born infants. The timing, dose, and route of administration of adrenaline are still debated, even though this medication has been used in neonatal resuscitation for a long time. According to the most recent Neonatal Resuscitation Guidelines from the American Heart Association, adrenaline use is indicated when the heart rate remains &lt; 60 beats per minute despite the establishment of adequate ventilation with 100% oxygen and chest compressions. The aforementioned guidelines recommend intravenous administration (via an umbilical venous catheter) of adrenaline at a do...

Introduction: After congenital hydrocephalus, spinal dysraphisms represent the second cause of neurosurgical consultation within the National Institute of Perinatology ‘Isidro Espinosa de los Reyes’ in Mexico City (INPer). The objective of the present study is to establish the demographic and epidemiological characteristics of live newborns with neural tube defects, during the past year. Material and methods: We carried out a descriptive, observational, retrospective study, including all live births within the Institute and diagnosis at discharge of cranial and/or spinal neural tube defects. The analysis is presented with descriptive statistics, using frequency tables, medians and ranges. Results: Fifteen live births with neural tube closure defects were recorded, of which 3 had more than one defect other than the Chiari malformation, and 80% presented hydrocephalus. All the mothers reported adequate intake of folate. There was no history of relatives with dysraphisms or maternal consumption of anti epileptic drugs. One patient with a closed defect developed fistula and infectious ventriculitis as a surgical complication. Conclusion: The number of cases attended in the INPer, due to neural tube defects, tripled compared to the previous year. The post natal care provided showed fewer complications than those reported in the literature, specifically infectious complications, due to timely multidisciplinary care and possibly due to the surgical closure of all open neural tube defects within the first 24 h

There is no consensus with regard to which charts are most suitable for monitoring the postnatal growth of preterm infants. We aimed to assess the strategies used to develop existing postnatal growth charts for preterm infants and their methodologic quality. A systematic review of observational longitudinal studies, whose primary objective was to create postnatal growth charts for preterm infants, was conducted. Thirty-eight items distributed in 3 methodologic domains (&quot;study design,&quot; &quot;statistical methods,&quot; and &quot;reporting methods&quot;) were assessed in each study. Each item was scored as a &quot;low&quot; or &quot;high&quot; risk of bias. Two reviewers independently selected the studies, assessed the risk of bias, and extracted data. A total quality score [(number of &quot;low risk&quot; of bias marks/total number of items assessed) × 100%] was calculated for each study. Median (range, IQR) quality scores for each methodologic domain and for all included st...

OBJECTIVES:
To develop quality of care (QoC) indicators, evaluate the quality of the processes of care (QPC) and clinical outcomes, and analyze the association between the QPC and severe clinical outcomes of preterm newborns admitted to neonatal intensive care units (NICUs).

DESIGN:
Mixed methods approach: (1) development of QoC indicators via modified RAND/UCLA method; (2) cross-sectional study of QoC evaluation and (3) multiple logistic regression analysis to ascertain the association between the QPC and severe clinical outcomes.

SETTING:
Two NICUs belonged to the Mexican Institute of Social Security in Mexico City.

PARTICIPANTS:
About 489 preterm neonates (<37 weeks of gestation) without severe congenital anomalies.

MAIN OUTCOME MEASURE(S):
The QoC indicators; ≥60% of recommended QPC and severe clinical outcomes.

RESULTS:
The QoC included 10 QPC indicators across four domains: respiratory, nutrition and metabolism, infectious diseases, and screening, and five outcome indicators. The lower QPC indicators were for the nutrition and metabolism domain (17.8% started enteral feeding with human milk, and 20.7% received sodium bicarbonate appropriately). The higher QPC indicator was for the screening domain (97.6% of neonates <30 weeks gestation underwent early (≤14 days) transfontanelar ultrasound). The mean recommended QPC that neonates received was 47.5%. Only 26.6% of neonates received ≥60% of recommended QPC. About 60.7% of neonates developed severe clinical outcomes including mortality and healthcare-related major morbidity. Receiving ≥60% of recommended QPC was associated with a decrease of nearly half of odds of severe clinical outcomes.

CONCLUSION:
The evaluation of the QoC in NICUs is essential to address modifiable gaps in quality.

SUMMARY
Objective. To evaluate the relationship of rupture of membranes > 12 hours to gastric fluid aspirate in the newborn.
Material and methods. They were carried out smear of gastric juice, obtained by means of aspiration, in 100 newborns to term, with
antecedent of rupture of membranes of more than 12 hours, without evidence clinic of infection intraamniotic. They were formed two
groups according to the time of rupture of membranes, the Group I with less than 12 hours (control) and the Group II with more than
12 hours. We correlated the values of total leukocytes reported in the hematic biometry, the speed of globular sedimentation and the
protein C it reactivates in blood of the umbilical cord.
Results: Significant difference existed among the Group I and the Group II (p < 0.01) in the number of white blood cells in the smear.
Conclusions. The number of white blood cells of the gastric fluid aspirate have equivalent diagnostic utility in neonates with rupture
of amniotic membranes. Another blood testing for infection had a low sensitivity for an intrauterine infection for a early evaluation.
Key words: Rupture of amniotic membranes, chorioamnionitis, gastric fluid.

Autosomal recessive congenital ichthyoses are a heterogeneous group of rare cornification diseases. Genetic mutations are responsible for the condition, with some causing a relatively milder phenotype such as 'self-improving collodion ichthyosis'. In most cases, affected babies are born with a thick parchment like membrane covering their body. These babies may have a problematic postnatal course, and are prone to complications. The authors present the report of a newborn collodion baby afflicted with ALOX12B mutation, who had a challenging post natal course. Difficulties in feeding, temperature control, hydration and electrolyte balance were encountered and required precise monitoring and formulation of an effective treatment strategy. Treatment of jaundice in the baby also presented a unique challenge, which was successfully managed.

Woman body undergoes postural changes during pregnancy process. These changes may impact on their physical conditions and lead to some limitations in daily activities. The aim of this research work is to evaluate the effect of a prenatal gymnastics program on changes in spinal curvature in pregnant women at Porto-Novo. Concerning methods, 120 women constituted the sample of the study, comprised of recruited purposive and divided into three groups: 32
pregnant women using antenatal gymnastics twice a week for eight weeks, 48 sedentary pregnant women and 40 sedentary non-pregnant women. The measurement of spinal curvatures took place at the beginning and the end of the study using with flexible ruler of mark Morn sun. The results showed that thoracic kyphosis and lumbar lordosis have increased and are significantly different between the three groups. These results suggest that prenatal gymnastics during pregnancy acts on the curvatures of the spine minimizing their emphasis.