Newborn Health

The neonatal mortality rate in India is high and stagnant. Special Care Newborn Units (SCNUs) have been set up to provide quality level II newborn-care services in several district hospitals to meet this challenge. The units are located in some remotest districts where the burden of neonatal deaths is high, and access to special newborn care is poor. The study was conducted to assess the functioning of SCNUs in eight rural districts of India. The evaluation was based on an analysis of secondary data from the eight units that had been functioning for at least one year. A cross-sectional survey was also conducted to assess the availability of human resources, equipment, and quality care. Descriptive statistics were used for analyzing the inputs (resources) and outcomes (morbidity and mortality). The rate of mortality among admitted neonates was taken as the key outcome variable to assess the performance of the units. Chi-square test was used for analyzing the trend of case-fatality rate over a period of 3-5 years considering the first year of operationalization as the base. Correlation coefficients were estimated to understand the possible association of case-fatality rate with factors, such as bed:doctor ratio, bed:nurse ratio, average duration of stay, and bed occupancy rate, and the asepsis score was determined. The rates of admission increased from a median of 16.7 per 100 deliveries in 2008 to 19.5 per 100 deliveries in 2009. The case-fatality rate reduced from 4% to 40% within one year of their functioning. Proportional mortality due to sepsis and low birthweight (LBW) declined significantly over two years (LBW <2.5 kg). The major reasons for admission and the major causes of deaths were birth asphyxia, sepsis, and LBW/prematurity. The units had a varying nurse:bed ratio (1:0.5-1:1.3). The bed occupancy rate ranged from 28% to 155% (median 103%), and the average duration of stay ranged from two days to 15 days (median 4.75 days). Repair and maintenance of equipment were a major concern. It is possible to set up and manage quality SCNUs and improve the survival of newborns with LBW and sepsis in developing countries, although several challenges relating to human resources, maintenance of equipment, and maintenance of asepsis remain.

A Quality Assurance model was rolled out in Bihar, India. It had two components: external and internal monitoring and giving feedback for action. The parameters included infrastructure and policy, equipment maintenance, stock supply and aseptic measures. The performance and gradation into good/average/poor was measured based on the scores translated from the data collected after giving appropriate weights. Results indicated that 12%, 63%, and 25% units were categorized as good, average and poor based on infrastructure. For equipment, 68% of units performed poorly; for stock maintenance 64% and 35% of NBCCs fell under good and average categories respectively; most (54%) NBCCs had average scores for aseptic measures; 30% fell in the poor category. Involvement of government in monitoring and feedback mechanism, establishing a system of data collection at the grass root level and analysis at the state level were the positive outcomes.

Early life experiences have long-lasting influence on a child. For an infant, the quality of caregiving is one of the most critical factors supporting growth and development. Adverse social events in infancy have the potency to alter the child’s developmental trajectory and elevate the lifetime risk for a range of psychiatric disorders. Although clinical studies associate early childhood adversities with lifetime risk for mental disorders, the knowledge of underlying neural and molecular alterations leading to these disorders comes mostly from animal studies. In this article, we overview selected animal models of early life social adversity, including maternal abuse and neglect, and maternal trauma and fear. We first characterize the major behavioral and neural changes normally occurring in early life. We then present several animal models of maternally mediated early life adversity that contribute to reorient the developmental changes toward pathological outcomes. These models yielded to recently identified neurobiological mechanisms, including epigenetic alterations, through which these adversities lead to a lasting dysregulation of the stress response system, aberrant fear learning and memory, and increased anxiety or depression-like behaviors.

A significant degradation in the health of wild animals in Montana has been recorded over the past two decades.
We surmise that the health issues are related to pesticide exposure. We present some of the evidence of the
deterioration of the health in wildlife, which we used to inspire investigations on human health in the US population.
While the animals’ exposure is through food, water and air, we believe that human exposure is predominantly
through food, as the majority of the population does not reside near agricultural fields and forests.
We have obtained US government data on pesticide usage and on human disease patterns over time from the
1998-2010 hospital discharge data. Since glyphosate is by far the most widely used herbicide, we believe it to be a
major source of contamination for humans. Correlations between glyphosate usage and specific health issues, along
with the known toxicology profile of glyphosate obtained from the literature, reflect a plausible causal relationship.
Because much of the wildlife data is from deer fawns, most of the human data presented here involve newborn
infants, but we also present some data for children 0-15 years old and for the full population (except newborn).
We found many diseases and conditions whose hospital discharge rates match remarkably well with the rate of
glyphosate usage on corn, soy, and wheat crops. These include head and face anomalies (R=0.95), newborn eye
disorders, newborn blood disorders (R=0.92), newborn skin disorders (R=0.96), lymph disorders in children 0-15
(R=0.86) and in the general population except newborn (R=0.89), congenital heart conditions in newborns (R= 0.98),
enlarged right ventricle in all age groups except newborn (R=0.96), newborn lung problems (R=0.95), pulmonary
bleeding and edema for all age groups except newborn (R=0.97), liver cancer for all age groups except newborn
(R=0.93), newborn metabolic disorders (R=0.95) and newborn genitourinary disorders (R=0.96).

Background
Globally, neonatal deaths remain a major public health challenge and account for the majority of deaths occurring among children under five years of age. Despite Nepal’s significant achievements in meeting the maternal and child health targets of the Millennium Development Goals, an estimated 23,000 Nepalese children under five years die every year, with three out of five babies dying within the first 28 days of life. This study therefore aimed to examine the level of knowledge and practices of newborn care among Nepalese mothers in the upper Himalayas and the factors associated with these.

Materials and methods
A community based cross-sectional study was conducted among 302 randomly selected mothers with children under two years of age in Tripurasundari Municipality of Dolpa district, an upper Himalayan region of Nepal. Mothers were interviewed using semi-structured questionnaires. Mean score for knowledge and Bloom’s criteria for practice were considered to categorize newborn care knowledge and practices. Multivariate logistic regression was used to identify factors associated with the newborn care knowledge and practices.

Results
In this study, 147 (48.7%) of the mothers were found to have inadequate knowledge of newborn care, while 102 (33.8%) mothers had reported unsatisfactory newborn care practices. Mothers with at least secondary level of formal education were more likely to possess adequate newborn care knowledge compared to mothers who never attended school (AOR 4.93 at 95% CI 1.82–13.33). Mothers whose first pregnancy occurred between the ages of 20–24 years (AOR 3.89 at 95% CI 1.81–8.37) were also more likely to possess adequate newborn care knowledge, compared to mothers with a younger age at first pregnancy. Furthermore, mothers who had completed at least four ANC visits (AOR 2.89 at 95% CI 1.04–7.96), mothers who had completed three PNC visits (AOR 2.79 at 95% CI 1.16–6.72) and mothers who reported that their nearest health facility was less than one hour (30–59 minutes) walking distance (AOR 3.66 at 95% CI 1.43–9.33) had higher odds of having adequate newborn care knowledge. Similarly, mothers whose household monthly income was more than $100 (AOR 4.17 at 95% CI 1.75–9.69), mothers who had completed three PNC visits (AOR 3.27 at 95% CI 1.16–9.20) and mothers with adequate newborn care knowledge (AOR 15.35 at 95% CI 5.82–40.47) were found to be more likely to practice a satisfactory level of newborn care practices in adjusted analysis.

Conclusion
The study revealed high prevalence of inadequate newborn care and knowledge amongst mothers in upper Himalayan dwellings. Approximately one third of all interviewed mothers practiced suboptimal newborn care. The results indicate an urgent need to increase awareness of neonatal services available to mothers and to prioritize investments by local governments in neonatal health services, in order to improve accessibility and quality of care for mothers and newborns.

Background: Neonatal and maternal health services have a bearing on neonatal mortality. Direct and indirect factors affecting neonatal health outcomes therefore require understanding to enable well-targeted interventions. This study, therefore, assessed the interrelationship between newborn health outcomes and maternal service utilization factors.

Carbon monoxide poisoning in pregnant women is a relatively rare condition. We report a 32-year-old
woman in her 32nd week of pregnancy found unconscious in the bathroom. On arrival, her pulse and blood
pressure were undetectable. Cardiopulmonary resuscitation was applied. The mother's carboxyhaemoglobin
level was 57%. Due to foetal distress, Caesarean section was performed in the emergency department. The
baby was intubated due to the absence of spontaneous respiration. The level of carboxyhaemoglobin in the
cord blood was 32%. After staying in the newborn unit for 47 days, the baby was discharged with a sequela
of cerebral palsy.

Introduction: To supply high-quality neonatal care, it is essential to provide adequate infrastructures and material. Exceeding the visible simplicity of this condition, we suggest analyzing finely the relationship between the arrangement of the care spaces in maternity, their uses, and the quality of the care delivered to the newborns. Method: An ethnographic investigation in ten hospitals of Cameroon, among which one by region chosen from the various levels of the sanitary pyramid, allowed us to examine how the arrangement of the sanitary spaces and the arrangement of the material could contribute to the vulnerability of the newborn in maternity wards. Two hundred observations of the care given at birth were transcribed, then used as support for interviews with healthcare professionals in the aims of explaining their actions. Results: The sanitary spaces, with habits and modes of organization, do not optimize the quality of the care to the newborns. The fragmentation of places used in the coverage of the newborn children engenders delays in care in case of complication at the birth. The ways in which the space and material are used in the wards reveal a lack of anticipation and coordination of care. The appropriations of places and arrangement of equipment are not favorable to recommended neonatal care practices, in particular concerning the fight against the hypothermia and the promotion of early breast-feeding. Indeed, the spatial organization in maternity wards appears to be more centered on the obstetrical care. Discussion: Reflecting on care spaces can provide a basis for local collective processes of improvement of newborn care practices. It allows to re-question the biomedical professional culture, the segmentation of the tasks and the techniques, and to durably anchor evolutions favorable to neonatal survival.

Background: Little information is available on the content of bisphenol A (BPA) and other endocrine-disrupting chemicals (EDCs) such as parabens in infant textiles and clothes. Objectives: 1) To determine the concentrations of BPA and parabens in socks for infants and young children purchased in Spain, 2) to assess the (anti-)estrogenicity and (anti-)androgenicity of extracts from the socks, and 3) to estimate dermal exposure doses to these chemicals. Methods: Thirty-two pairs of socks for infants and young children (1-48 months) were purchased from 3 stores in Granada (Spain). Textile material was cut from the foot, toe, and leg of each sock (n = 96 samples) for chemical analysis. Hormone-like activities were determined in foot sections (n = 32 samples) by using the E-Screen assay for (anti-)estrogenicity and PALM luciferase assay for (anti-)androgenicity. Results: BPA was present in 90.6% of samples at concentrations ranging from < 0.70 to 3736 ng/g. BPA levels were around 25-fold higher in socks from store 1, which had a higher cotton content compared to stores 2 and 3. Ethyl-paraben was found in 100% of samples, followed by methyl-paraben (81.0%), and propyl-paraben (43.7%). No butyl-paraben was detected in any sample. Estrogenic activity was detected in 83.3% of socks from store 1 (range = 48.2-6051 pM E 2 eq/g) but in only three socks from stores 2 and 3. Anti-androgenic activity was detected in six of the 32 socks studied (range = 94.4-2989 μM Proceq/g), all from store 1. Estimated dermal exposure to BPA was higher from socks for children aged 36-48 months (median = 17.6 pg/kg/day), and dermal exposure to parabens was higher from socks for children aged 24-36 months (median = 0.60 pg/kg/day). Discussion: This is the first report in Europe on the wide presence of BPA and parabens in socks marketed for infants and children. BPA appears to contribute to the hormone-like activity observed in sock extracts.

Background: Sickle Cell Disease (SCD) has been designated by WHO as a public health problem in sub-Saharan Africa, and the development of newborn screening (NBS) is crucial to the reduction of high SCD morbidity and mortality. Strategies from the field of implementation science can be useful for supporting the translation of NBS evidence from high income countries to the unique cultural context of sub-Saharan Africa. One such strategy is community engagement at all levels of the healthcare system, and a widely-used implementation science framework, "Getting to Outcomes ® " (GTO), which incorporates continuous multilevel evaluation by stakeholders about the quality of the implementation. Objectives: (1) to obtain critical information on potential barriers to NBS in the disparate ethnic groups and settings (rural and urban) in the healthcare system of Kaduna State in Nigeria; and, (2) to assist in the readiness assessment of Kaduna in the implementation of a sustainable NBS programme for SCD. Methods: Needs assessment was conducted with stakeholder focus groups for two days in Kaduna state, Nigeria, in November 2017. Results: The two-day focus group workshop had a total of 52 participants. Asking and answering the 10 GTO accountability questions provided a structured format to understand strengths and weaknesses in implementation. For example, we found a major communication gap between policy-makers and user groups. Conclusion: In a two-day community engagement workshop, stakeholders worked successfully together to address SCD issues, to engage with each other, to share knowledge, and to prepare to build NBS for SCD in the existing healthcare system.