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Maternity Ward (maternity + ward)
Selected AbstractsRecurrence of kernicterus in term and near-term infants in DenmarkACTA PAEDIATRICA, Issue 10 2000F Ebbesen Classical acute bilirubin encephalopathy (kernicterus) in term and near-term infants had not been seen in Denmark for at least 20 y until 1994. From 1994 to 1998, however, six cases were diagnosed. Aetiology of the hyperbilirubinaemia was known in two infants; spherocytosis and galactosaemia, most likely known in two infants; possible A-O blood type immunization, and unknown in two infants. However, one of these last-mentioned infants had a gestational age of only 36 wk. The maximum plasma total bilirubin concentrations were 531,745 ,mol/L. The increase in the number of cases of kernicterus was considered to have been caused by: (i) a decreased awareness of the pathological signs, (ii) a change in the assessment of the risk of bilirubin encephalopathy, (iii) early discharge of the infants from the maternity ward, (iv) so-called breastfeeding-associated jaundice, (v) demonstration of bilirubin being an antioxidant, and (vi) difficulty in estimating the degree of jaundice in certain groups of immigrants. Accordingly, for prevention: (a) Attempt to change the healthcare workers' understanding of the risk of bilirubin encephalopathy, (b) give further instructions, both orally and in writing, to mothers before discharge from the maternity ward, (c) be more liberal in giving infant formula supplements, (d) conduct home visits by the community nurse at an earlier stage, (e) follow authorized guidelines for phototherapy and exchange transfusion, (f) lower plasma bilirubin concentration limits as an indication for phototherapy and exchange transfusion, (g) screen all term and near-term infants, and (h) measure the skin's yellow colour with a device that corrects for the skin's melanin content. Conclusions: Audit of the six cases presented indicates that measures are necessary in both the primary and secondary healthcare sectors if the risk of kernicterus is to be avoided. Screening may be considered, but in order to identify the problems it would first be reasonable to perform a larger prospective study in which audit is performed on all newborn infants, born at term and near-term, who develop a plasma bilirubin concentration above the exchange transfusion limit. [source] Congenital toxoplasmosis: late pregnancy infections detected by neonatal screening and maternal serological testing at deliveryPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 6 2007Eleonor G. Lago Summary The first aim of this study was to determine the prevalence of congenital toxoplasmosis in newborn infants treated by the public health system in Porto Alegre, a city in southern Brazil, using neonatal screening for Toxoplasma gondii -specific IgM. The second aim was to investigate whether the cases detected by this approach could have been identified by the prenatal screening for antibodies to T. gondii that was performed in the same population. A fluorometric assay was used to analyse T. gondii -specific IgM in filter paper specimens obtained from newborn infants for routine screening for metabolic diseases. When the specific IgM was positive, serum samples from the infant and the mother were requested for confirmatory serological testing, and the infant underwent clinical examination. Among 10 000 infants screened for T. gondii -specific IgM, seven filter paper samples were positive, and congenital toxoplasmosis was confirmed in six patients. The prevalence of IgM specific for T. gondii was 6/10 000 [95% CI 2/10 000, 13/10 000]. One infected infant had already been identified in the maternity ward before birth, three had been identified by maternal serology at delivery, and two infants with congenital toxoplasmosis were identified solely through neonatal screening. Although four mothers of the patients with congenital toxoplasmosis received prenatal care, and three mothers had one or two serological tests for T. gondii -specific antibodies (one at first trimester, one at first and second trimesters, and the other at second and third trimesters), they were not identified during pregnancy as infected. Neonatal screening identified cases of infection not detected by obtaining only one or two serum samples from pregnant women for T. gondii serology, mainly when infection was acquired and transmitted in late pregnancy. Maternal serology at delivery and neonatal screening were especially useful in the identification of infants with congenital toxoplasmosis when the mother did not receive regular prenatal serological testing or prenatal care. [source] The colonization incidence of group B streptococcus in pregnant women and their newborns in IstanbulPEDIATRICS INTERNATIONAL, Issue 1 2005Ilikkan Barbaros Abstracts,Background:,This study was designed to determine the incidence of group B Streptococcus (GBS) colonization in pregnant women and newborns, and to evaluate the antimicrobial resistance during delivery. Methods:,A total of 300 pregnant women and their newborns were enrolled in this prospective study performed in the maternity ward of Cerrahpasa Medical Faculty and Bakirkoy SSK Hospital, Istanbul, Turkey. Samples were collected from pregnant women and their newborns in the delivery room. Results:,GBS was isolated from 24 women and the colonization rate was found to be 8%. Two newborns were colonized with GBS. None of the isolates were resistant to penicillin, whereas 20% showed resistance to erythromycin and clindamycin. Conclusion:,Screening and antimicrobial susceptibility testing of GBS during pregnancy show similiar results with other studies performed in different regions of our country. [source] The Gudaga Study: establishing an Aboriginal birth cohort in an urban communityAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2010Elizabeth Comino Abstract Objective: This paper describes the establishment of the Gudaga Study, an Aboriginal birth cohort in south-west Sydney, and our approach to follow-up of participants. The Study describes the health, development, and services use of Aboriginal infants and their mothers. The research team works closely with the local Aboriginal community to implement the research. Methods: All mothers in the maternity ward of an urban hospital were surveyed to identify mothers with an Aboriginal infant. These and some additional mothers identified through other networks were recruited to the study. Results: The number of mothers were surveyed was 2,108. Mothers of Aboriginal infants were younger (25.3 years compared to 28.4 years, p<0.001), less likely to be married (16.1% cf. 58.4%, p<0.001) and to have completed school (63.2% cf. 77.8%, p=0.002) than mothers of non-Aboriginal infants. Of 155 identified mothers of Aboriginal infants, 136 were recruited and 23 through other networks. At 12 months, 85.5% of infants were followed up. Conclusions: This study, to our knowledge, is the first cohort study of this kind on the eastern seaboard of Australia. The study has strong community support and follow-up, contrary to views that Aboriginal people are reluctant to participate in research. These data have national and regional significance. [source] Early Contact versus Separation: Effects on Mother,Infant Interaction One Year LaterBIRTH, Issue 2 2009Ksenia Bystrova MD ABSTRACT: Background: A tradition of separation of the mother and baby after birth still persists in many parts of the world, including some parts of Russia, and often is combined with swaddling of the baby. The aim of this study was to evaluate and compare possible long-term effects on mother-infant interaction of practices used in the delivery and maternity wards, including practices relating to mother-infant closeness versus separation.Methods:A total of 176 mother-infant pairs were randomized into four experimental groups: Group I infants were placed skin-to-skin with their mothers after birth, and had rooming-in while in the maternity ward. Group II infants were dressed and placed in their mothers' arms after birth, and roomed-in with their mothers in the maternity ward. Group III infants were kept in the nursery both after birth and while their mothers were in the maternity ward. Group IV infants were kept in the nursery after birth, but roomed-in with their mothers in the maternity ward. Equal numbers of infants were either swaddled or dressed in baby clothes. Episodes of early suckling in the delivery ward were noted. The mother-infant interaction was videotaped according to the Parent-Child Early Relational Assessment (PCERA) 1 year after birth.Results:The practice of skin-to-skin contact, early suckling, or both during the first 2 hours after birth when compared with separation between the mothers and their infants positively affected the PCERA variables maternal sensitivity, infant's self-regulation, and dyadic mutuality and reciprocity at 1 year after birth. The negative effect of a 2-hour separation after birth was not compensated for by the practice of rooming-in. These findings support the presence of a period after birth (the early "sensitive period") during which close contact between mother and infant may induce long-term positive effect on mother-infant interaction. In addition, swaddling of the infant was found to decrease the mother's responsiveness to the infant, her ability for positive affective involvement with the infant, and the mutuality and reciprocity in the dyad.Conclusions:Skin-to-skin contact, for 25 to 120 minutes after birth, early suckling, or both positively influenced mother-infant interaction 1 year later when compared with routines involving separation of mother and infant. [source] A comparison between criteria for diagnosing atopic eczema in infantsBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2005H. Jøhnke Summary Background, Epidemiological studies have shown different estimates of the frequency of atopic eczema (AE) in children. This may be explained by several factors including variations in the definition of AE, study design, age of study group, and the possibility of a changed perception of atopic diseases. The role of IgE sensitization in AE is a matter of debate. Objectives, To determine the prevalence and cumulative incidence of AE in a group of unselected infants followed prospectively from birth to 18 months of age using different diagnostic criteria; to evaluate the agreement between criteria; and to describe the association between atopic heredity and postnatal sensitization, respectively, and the development of AE according to the different diagnostic criteria. Methods, During a 1-year period a consecutive series of 1095 newborns and their parents were approached at the maternity ward at the Odense University Hospital, Denmark and a cohort of 562 newborns was established. Infants were examined and followed prospectively from birth and at 3, 6, 9, 12 and 18 months of age. AE was diagnosed using four different criteria, the Hanifin and Rajka criteria, the Schultz-Larsen criteria, the Danish Allergy Research Centre (DARC) criteria developed for this study and doctor-diagnosed visible eczema with typical morphology and atopic distribution. Additionally, the U.K. diagnostic criteria based on a questionnaire were used at 1 year of age. Agreement between the four criteria was analysed at each time point and over time, and agreement between the four criteria and the U.K. questionnaire criteria was analysed. Results, The cumulative 1-year prevalence of AE using the Hanifin and Rajka criteria was 9·8% (95% confidence interval, CI 7,13%), for the Schultz-Larsen criteria it was 7·5% (95% CI 5,10%), for the DARC criteria 8·2% (95% CI 6,11%), for visible eczema 12·2% (95% CI 9,16%) and for the U.K. criteria 7·5% (95% CI 5,10%). The pairwise agreement between criteria showed good agreement, with rates varying between 93% and 97% and kappa scores between 0·6 and 0·8. Agreement analysis of diagnoses between the four criteria demonstrated that cumulative incidences showed better agreement than point prevalence values. Conclusions, Agreement between different criteria for diagnosing AE was acceptable, but the mild cases constituted a diagnostic problem, although they were in the minority. Repeated examinations gave better agreement between diagnostic criteria than just one examination. Atopic heredity was less predictive for AE than sensitization to common food and inhalant allergens in early childhood. [source] Diabetic mothers and their newborn infants , rooming-in and neonatal morbidityACTA PAEDIATRICA, Issue 7 2010E Stage Abstract Aim:, As a result of increased neonatal morbidity, the infants of diabetic mothers have routinely been admitted to a neonatal special care unit (NSCU). We therefore investigated whether the offer of rooming-in diabetic mothers and their newborn infants has an effect on neonatal morbidity. Methods:, The records of an old cohort of 103 infants routinely admitted to the NSCU, and a new cohort (N = 102), offered rooming-in were assessed for neonatal morbidity. Results:, Eighty-four (82%) of the new cohort infants followed their mothers to the maternity ward; whereas 19 (18%) were transferred to the NSCU chiefly because of prematurity. Ten infants were later transferred to the NSCU for minor problems. Neonatal morbidity and neonatal hypoglycaemia were significantly less common in the new cohort than in the old cohort [27 (26%) vs. 55 (54%), p < 0.001 and 42 (41%) vs. 64 (63%), p = 0.0027 respectively]. Maternal HbA1c in late pregnancy was significantly lower in the new cohort, but the only independent predictors of neonatal morbidity were belonging to the old cohort and preterm delivery. Conclusion:, Neonatal care with rooming-in mothers with type 1 diabetes and their newborn infants seems safe and is associated with reduced neonatal morbidity, when compared with routine separation of infants from their mothers. [source] Neonatal hip instability: results and experiences from ten years of screening with the anterior-dynamic ultrasound methodACTA PAEDIATRICA, Issue 8 2002JE Andersson Aim: To record the results and experiences from a 10-y screening period with the anterior-dynamic ultrasound method for detecting neonatal hip instability. Methods: An ultrasonographic improvement of the Palmen/Barlow test was used. The screening programme included 22 047 newborns. Decisions about treatment were made solely on the ultrasound result. Results: It was found that 175 infants (7.9/1000) had at least one unstable hip,dislocated or dislocatable. Dislocated hips were found in 1.1/1000. Dislocatable hips were found in 6.8/1000 but only 1.1/1000 needed treatment. The total frequency of treatment was 2.2/1000. All cases but one were diagnosed before discharge from the maternity ward. The rate of surgery was 0.1/1000 newborns. Girls were more affected than boys, by a ratio of 3:1. Among the affected hips 64.4% were a left hip. Conclusion: Neonatal hip instability is always present at birth and can be diagnosed immediately after birth. We have no indications that instability can appear at a later stage. The anterior-dynamic ultrasound screening programme is an efficient tool to diagnose neonatal hip instability and to decide when to begin treatment. [source] Effects of HIV/AIDS on Maternity Care Providers in KenyaJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 5 2008Janet M. Turan ABSTRACT Objective: To explore the impact of HIV/AIDS on maternity care providers in labor and delivery in a high HIV-prevalence setting in sub-Saharan Africa. Design: Qualitative one-on-one in-depth interviews with maternity care providers. Setting: Four health facilities providing labor and delivery services (2 public hospitals, a public health center, and a small private maternity hospital) in Kisumu, Nyanza Province, Kenya. Participants: Eighteen maternity care providers, including 14 nurse/midwives, 2 physician assistants, and 2 physicians (ob/gyn specialists). Results: The HIV/AIDS epidemic has had numerous adverse effects and a few positive effects on maternity care providers in this setting. Adverse effects include reductions in the number of health care providers, increased workload, burnout, reduced availability of services in small health facilities when workers are absent due to attending HIV/AIDS training programs, difficulties with confidentiality and unwanted disclosure, and maternity care providers' fears of becoming HIV infected and the resulting stigma and discrimination. Positive effects include improved infection control procedures on maternity wards and enhanced maternity care provider knowledge and skills. Conclusion: A multifaceted package including policy, infrastructure, and training interventions is needed to support maternity care providers in these settings and ensure that they are able to perform their critical roles in maternal healthcare and prevention of HIV/AIDS transmission. [source] Early Contact versus Separation: Effects on Mother,Infant Interaction One Year LaterBIRTH, Issue 2 2009Ksenia Bystrova MD ABSTRACT: Background: A tradition of separation of the mother and baby after birth still persists in many parts of the world, including some parts of Russia, and often is combined with swaddling of the baby. The aim of this study was to evaluate and compare possible long-term effects on mother-infant interaction of practices used in the delivery and maternity wards, including practices relating to mother-infant closeness versus separation.Methods:A total of 176 mother-infant pairs were randomized into four experimental groups: Group I infants were placed skin-to-skin with their mothers after birth, and had rooming-in while in the maternity ward. Group II infants were dressed and placed in their mothers' arms after birth, and roomed-in with their mothers in the maternity ward. Group III infants were kept in the nursery both after birth and while their mothers were in the maternity ward. Group IV infants were kept in the nursery after birth, but roomed-in with their mothers in the maternity ward. Equal numbers of infants were either swaddled or dressed in baby clothes. Episodes of early suckling in the delivery ward were noted. The mother-infant interaction was videotaped according to the Parent-Child Early Relational Assessment (PCERA) 1 year after birth.Results:The practice of skin-to-skin contact, early suckling, or both during the first 2 hours after birth when compared with separation between the mothers and their infants positively affected the PCERA variables maternal sensitivity, infant's self-regulation, and dyadic mutuality and reciprocity at 1 year after birth. The negative effect of a 2-hour separation after birth was not compensated for by the practice of rooming-in. These findings support the presence of a period after birth (the early "sensitive period") during which close contact between mother and infant may induce long-term positive effect on mother-infant interaction. In addition, swaddling of the infant was found to decrease the mother's responsiveness to the infant, her ability for positive affective involvement with the infant, and the mutuality and reciprocity in the dyad.Conclusions:Skin-to-skin contact, for 25 to 120 minutes after birth, early suckling, or both positively influenced mother-infant interaction 1 year later when compared with routines involving separation of mother and infant. [source] Effectiveness of educational materials designed to change knowledge and behaviors regarding crying and shaken-baby syndrome in mothers of newborns: a randomized, controlled trialCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 4 2009Richard Reading Effectiveness of educational materials designed to change knowledge and behaviors regarding crying and shaken-baby syndrome in mothers of newborns: a randomized, controlled trial . BarrR. G., RivaraF. P., BarrM., CummingsP., TaylorJ., LenguaL. J. & Meredith-BenitzE. ( 2009 ) Pediatrics , 123 , 972 , 980 . DOI: 10.1542/peds.2008-0908 . Background Infant crying is an important precipitant for shaken-infant syndrome. Objective To determine if parent education materials [The Period of PURPLE Crying (PURPLE)] change maternal knowledge and behaviour relevant to infant shaking. Methods This study was a randomized, controlled trial conducted in prenatal classes, maternity wards and pediatric practices. There were 1374 mothers of newborns randomly assigned to the PURPLE intervention and 1364 mothers to the control group. Primary outcomes were measured by telephone 2 months after delivery. These included two knowledge scales about crying and the dangers of shaking; three scales about behavioural responses to crying generally and to unsoothable crying, and caregiver self-talk in response to unsoothable crying; and three questions concerning the behaviours of sharing of information with others about crying, walking away if frustrated and the dangers of shaking. Results The mean infant crying knowledge score was greater in the intervention group (69.5) compared with controls (63.3). Mean shaking knowledge was greater for intervention subjects (84.8) compared with controls (83.5). For reported maternal behavioural responses to crying generally, responses to unsoothable crying, and for self-talk responses, mean scores for intervention mothers were similar to those for controls. For the behaviours of information sharing, more intervention mothers reported sharing information about walking away if frustrated and the dangers of shaking, but there was little difference in sharing information about infant crying. Intervention mothers also reported increased infant distress. Conclusions Use of the PURPLE education materials seem to lead to higher scores in knowledge about early infant crying and the dangers of shaking, and in sharing of information behaviours considered to be important for the prevention of shaking. [source] | ||||||||||||||||||||||