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Objective: To determine the utility of microscopic examination and culture of endotracheal aspirate (ETA) in the early diagnosis of ventilator-associated pneumonia (VAP) in preterm neonates. Methods: We enrolled 80 consecutive neonates (both inborn and out-born) with gestational age of < 37 weeks admitted in Special Newborn Care Unit (SNCU) and requiring mechanical ventilation (MV) for > 48 hours. The diagnosis of VAP was made using the criteria laid down by the Centers for Disease Control (CDC). Results: 47 preterm neonates (58.5%) developed VAP; the overall incidence was 74.7/1000 ventilator-days. The mean (SD) time (hours) to ETA culture was less as compared to diagnosis based on CDC criteria [108.9 (8.00 hrs) vs 132.4 (53.24); P = 0.004] with sensitivity and specificity of 80.8% and 72.7%, respectively. Outborn delivery was the single most important risk factor for VAP. Multidrug resistant (MDR) Klebsiella pneumoniae (63.9%) was the most prevalent organism. Conclusions: We noticed a very high incidence of VAP among preterm neonates in SNCU. ETA culture can aid in early diagnosis. [ABSTRACT FROM AUTHOR]

Background: Newborn period is the most vulnerable period of life. As the rate of decline in neonatal mortality was slow compared to infant mortality rate, improved neonatal health-care services were started in existing facilities under facility-based newborn care program. Materials and Methods: A total of six special newborn care units at the district hospitals and 12 newborn stabilization units at the subdistrict/rural hospitals were included in the study. The outcome parameters were analyzed in the admitted babies using statistical tests. RESULTS: The mortality pattern was higher among low-birth-weight and preterm babies. The lower health-care centers had less neonatal deaths, as the neonates were referred. The common causes of admission were neonatal jaundice, respiratory distress syndrome, birth asphyxia, and so on. Conclusion: The focus on the high-risk babies needs to be strengthened, as these babies are at a high risk for neonatal mortality. [ABSTRACT FROM AUTHOR]

Introduction: Kangaroo Mother Care (KMC) and optimal feeding in Low Birth Weight (LBW) infants are evidence based cost effective interventions which if properly implemented across all facilities can help to save millions of newborn. The study, focussing on status of KMC services in Gujarat State, has not been conducted so far. Objectives: The intent of present study was to ascertain the infrastructure, facilities, policies and practices related to Kangaroo Mother Care at special newborn care units (SNCUs) of various regions of Gujarat and to suggest strategies for effective delivery of KMC services. Methods: A pre tested, semi structured and validated questionnaire including general information about SNCU, baseline data about KMC protocols and practices of each SNCU etc. was developed. The information was collected from all 40 Special Newborn Care Units (SNCUs) of Gujarat State of India.The data analysis was performed using EpiInfo 7 Statistical Software developed by Centres for Disease Control and Prevention (CDC), Atlanta. Simple frequency tables were used for analysis. Results: About 81% of the facilities reported that newborns with birth weight less than 2000 grams, either stable or with non-serious medical conditions were eligible for receiving KMC. None of the facilities were providing continuous KMC more than 12 hours. Thirty (81.08%) SNCUs had an earmarked space for performing KMC either in the form of separate ward or identified corner in the ward. Conclusion: The present study revealed inadequate Kangaroo Mother Care services in selected newborn care units of Gujarat State of India. The services, especially basic facilities like drinking water, food, toilet and hand washing was not available in some of the facility.

Introduction: Facility Based Newborn Care (FBNC) is a critical intervention to improve child survival & to reduce neonatal mortality rate Neonatal Mortality Rate (NMR) is major challenge.Objectives: Toanalyze morbidity profile of neonates admitted in special newborn care units of a tertiary level hospitals and medical college attached hospitals of Gujarat State. Method: A cross sectional descriptive study where record based secondary data collected & analysed for key indicators from all Govt. supported Sick Newborn Care Unit (SNCUs) which are in Medical college attached hospitals, district hospitals and grant in aid trust hospitals. April 2014 to March 2016 was the study period. Results: The study found near proportions of (53%) inborn, (47%) out born admission and 44% admission of female. Out of 69,662 admissions, 67% were discharged, 16% died, 10% leaving against medical advice, and 7% referred to higher centers. Major reasons for admission were respiratory distress syndrome (RDS) (22%) and infection (21%). Conclusion: Strengthening of appropriate facility care is essential to address neonatal mortality. The health interventions needed to tackle NMR differ from those needed for infant mortality rate and under-five mortality rate.

Context: Facility Based Newborn Care (FBNC) is a key strategy to improve child survival, especially in newborn care where neonatal mortality rate (NMR) is stagnant in declining. Gujarat has achieved considerable amount of reduction in child deaths, but neonatal health requires attention. The study was aimed to assess the admission pattern of Special Newborn Care Units (SNCUs) which supports decision-making. Settings and Design: A cross-sectional descriptive analysis was done from secondary data of the SNCU reports on the aspects of admission patterns, morbidity, and mortality pattern. The reports had been analyzed on various critical variables. Results: In 2015–2016, Gujarat has operationalized forty SNCUs by saturating each district with at least one SNCU. The study found near proportions of (53%) inborn – (47%) outborn admission and 44% admission of female. Out of 69,662 admissions, 67% were discharged, 16% died, 10% leaving against medical advice, and 7% referred to higher centers. Major reasons for admission were respiratory distress syndrome (RDS) (22%) and infection (21%). Similar pattern in mortality found as final diagnosis of deaths was RDS (23%) and infection (21%). The proportion of neonatal deaths in outborn was high compared to inborn. Conclusion: Strengthening of FBNC is essential to address neonatal mortality. NMR is of prime focus because the health interventions needed to tackle NMR differ from those needed for infant mortality rate and under-five mortality rate. This accentuates the need for focused attention on facility- and community-based child health interventions along with quality maternal health services and robust referral mechanisms to all delivery points.

Context: Facility Based Newborn Care (FBNC) is a key strategy to improve child survival, especially in newborn care where neonatal mortality rate (NMR) is stagnant in declining. Gujarat has achieved considerable amount of reduction in child deaths, but neonatal health requires attention. The study was aimed to assess the admission pattern of Special Newborn Care Units (SNCUs) which supports decision-making. Settings and Design: A cross-sectional descriptive analysis was done from secondary data of the SNCU reports on the aspects of admission patterns, morbidity, and mortality pattern. The reports had been analyzed on various critical variables. Results: In 2015-2016, Gujarat has operationalized forty SNCUs by saturating each district with at least one SNCU. The study found near proportions of (53%) inborn - (47%) outborn admission and 44% admission of female. Out of 69,662 admissions, 67% were discharged, 16% died, 10% leaving against medical advice, and 7% referred to higher centers. Major reasons for admission were respiratory distress syndrome (RDS) (22%) and infection (21%). Similar pattern in mortality found as final diagnosis of deaths was RDS (23%) and infection (21%). The proportion of neonatal deaths in outborn was high compared to inborn. Conclusion: Strengthening of FBNC is essential to address neonatal mortality. NMR is of prime focus because the health interventions needed to tackle NMR differ from those needed for infant mortality rate and under-five mortality rate. This accentuates the need for focused attention on facility- and community-based child health interventions along with quality maternal health services and robust referral mechanisms to all delivery points. [ABSTRACT FROM AUTHOR]

Background: There has been an increased emphasis on institutional births, and thus an increasing clinical work load for health care professionals in the recent past. Hence, continuing education, training, ongoing supervision, and mentorship of health care professionals working in these health facilities with easy access to guidelines in a cost effective manner has become a challenging task. With the increased emphasis on institutional births, and an increasing clinical work load, continuing education and training of health care professional managing these health facilities, their ongoing supervision, mentorship, with ready availability of guidelines in a cost effective manner becomes imperative and is a challenging task. Training opportunities can be linked to mobile electronic devices and 'Apps' to improve the care of seriously ill newborn. The aim of this study was to evaluate the efficacy of an innovative point of care tool-Android based App- 'AIIMS-WHO CC STPs' on the knowledge, skill scores, and satisfaction among Special Newborn Care Unit (SNCU) physicians managing sick neonates. Methods: The baseline knowledge and skill scores of pediatricians working in SNCUs in the state of Tamil Nadu, India (n = 32) were assessed by 25 multiple choice questions (MCQs) and by five Objective Structured Clinical Examination (OSCE) skill stations. The training was conducted in a single-day workshop using the app on four modules followed by post-training assessment of knowledge and skill scores after 3 weeks using the same. The satisfaction was assessed by mixed method approach using Likert's scale and focus group discussion (FGD) after 3 weeks. Results: The mean knowledge scores [19.4 (2.6) vs. 10.7 (3.2); maximum marks (MM) 25, mean difference 8.7 (95 % CI 7.6 to 9.9)], and the composite mean skill scores [55.2 (5.8) and 42 (6.2), MM 75, mean difference 13.2 (95 % CI 10.4 to 15.9)] improved after training. The median (IQR) satisfaction score with the course was 4 (4 to 5) (Likert's scale). Focus group discussion revealed that the physicians were overall satisfied using the device. They expressed overall satisfaction on the teaching methodology using wall charts, simulators, and device. Conclusion: Training SNCU physicians on Android based App- 'AIIMS-WHO CC STPs' improved their knowledge and skills. This app may have a potential role as a supplement to other modalities in training doctors for improving newborn care. [ABSTRACT FROM AUTHOR]