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Indian Pediatr 2019;56: 610 |
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Clippings
Theme: Neonatology
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Sriparna Basu
Email: [email protected]
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Trends in neonatal mortality
(1990-2017), with projections to 2030 (Lancet Glob Health.
2019;7:e710-20)
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Improving neonatal mortality rate (NMR) is an essential component of
reducing under-5 mortality rate (U-5MR). To achieve the current target
of Sustainable Development Goals (SDGs) of ending preventable deaths of
neonates and under-5 children by 2030, all countries should aim to
reduce the NMR to 12 deaths/1000 livebirths. This systematic analysis
estimated how different NMR targets could affect the actual burden of
neonatal mortality from 2018 to 2030 using the present NMR data of 195
countries. Between 1990 and 2017, the global NMR decreased by 51% (36·6
deaths/1000 livebirths in 1990 to 18·0 deaths/1000 livebirths in 2017).
Total neonatal deaths during the same period decreased from 5·0 to 2·5
million. West and Central Africa had the highest NMR in 2017 – at 30·2
deaths/1000 livebirths – followed by South Asia, at 26·9 deaths/1000
livebirths. Though all regions have reported reductions in NMR since
1990, South Asia, including India, reported a consistently and
significantly higher ratio of NMR to U-5MR over the last 25 years. It
has been projected that between 2018 and 2030, 27·8 million neonates
will die if each country maintains its current rate of reduction in NMR.
If each country achieves the SDG NMR target by effective implementation
of continuum of care during pre-pregnancy, antenatal, intrapartum,
delivery, postpartum, and postnatal periods for mothers and their
newborns, neonatal deaths will reduce to 1·2 million in 2030.
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Increased early enteral zinc intake improves weight gain in
hospitalized preterm infants (Acta Pediatr. May 01,
2019.doi.org/10.1111/apa.14828)
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This cohort study showed that enteral zinc intake
during neonatal intensive care unit (NICU) stay was associated with
improved growth in 105 preterm infants. Multiple regression analysis
showed that higher total enteral zinc intake was positively correlated
with increase in weight and head circumference, after correcting
post-menstrual age at birth.
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Oxygen saturation alarm settings, and
morbidity and mortality in preterm infants (J Pediatr.
2019;209:17-22)
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Even after five large randomized controlled trials, the choice of lower
(85%-89%) vs. higher (91%-95%) target pulse oximetry oxygen saturation
(SpO2) range to reduce mortality and morbidity of preterm infants
remains elusive. This retrospective cohort study evaluated the impact of
policy changes (narrowing the SpO2alarm limits) in very preterm infants.
Records of 3809 infants in 10 hospitals with an SpO2 alarm policy
change, and 3685 infants in 9 hospitals without a policy change, were
reviewed. Mortality was lower in hospitals without a policy change
(Adjusted Odds Ratio (aOR) 0.63; 95% CI 0.50, 0.80) but did not differ
between epochs in hospitals with changed policy. The odds of
bronchopulmonary dysplasia were greater for hospitals with a policy
change (aOR 1.65; 95% CI 1.36, 2.00) but did not differ for hospitals
without a policy change. Severe retinopathy of prematurity (ROP) and
necrotizing enterocolitis did not differ between epochs for either
group. Authors concluded that changing SpO2 alarm policies was not
associated with reduced mortality or increased/severe ROP among very
preterm infants.
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Association between
borderline low Apgar scores, and neonatal mortality and
morbidity in term infants (BMJ. 2019;365:l1656)
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This population-based cohort study examined the associations between 1,
5, and 10 minutes Apgar scores of 7, 8 and 9 versus 10 with
neonatal mortality and morbidity in 1,551,436 normal term live singleton
infants born between 1999 and 2016 with Apgar scores of
³7 at 1, 5, and 10
minutes. Compared to infants with an Apgar score of 10, neonatal
mortality, infections, post-asphyxial complications, respiratory
distress, and hypoglycemia were higher among infants with lower Apgar
scores, especially at 5 and 10 minutes. The authors concluded that
target Apgar score for all newborns should be 10 at each point of time
as a small change in Apgar score from 5 minutes to 10 minutes, even
within the normal range of 7 to 9, was linked to higher neonatal
morbidity risks.
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Community-based
antibiotic delivery for possible serious bacterial infections
in neonates in low- and middle-income countries (Cochrane Database
Syst Rev. 2019;4:CD007646) |
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This meta-analysis assessed the effects of community-based antibiotics
for neonatal possible serious bacterial infection (PSBI) in low- and
middle-income countries (LMICs), and whether such effects differ
according to the antibiotic regimen. It was found that community-based
antibiotic delivery for neonatal PSBI reduced neonatal mortality
compared to hospital referral (RR 0.82, 95% CI 0.68 to 0.99; 5 studies,
n=125,134; low-quality evidence). It also showed a possible
effect on reducing sepsis-specific neonatal mortality (RR 0.78, 95% CI
0.60 to 1.00; 2 studies, n=40,233; low-quality evidence). Using a
simplified antibiotic approach resulted in similar rates of neonatal
mortality when compared to the standard 7-day regimen of injectable
procaine benzyl penicillin and injectable gentamicin delivered in
community-settings for neonatal PSBI (RR 0.81, 95% CI 0.44 to 1.50; 3
studies, n=3476; moderate-quality evidence). Other approaches
including 7-day regimen of oral amoxicillin and injectable gentamicin or
2-day regimen of injectable benzylpenicillin and injectable gentamicin
or injectable gentamicin and oral amoxicillin, followed by oral
amoxicillin for 5 days, also showed no difference in neonatal mortality
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