Background:Bronchopulmonary dysplasia (BPD) is a chronic lung disease with asignificant cause of morbidity and mortality in preterm infants.Prevention and early diagnosis are critical for preventing disease progression.We hypothesized we could show the potential mechanism of early inflammation with increasing peripheral hematologic inflammatory markers
Objective:As lung inflammation plays an important role in pathogenesis, we aimed to determine the predictive role of systemic inflammatory biomarkers for BPD.
Methods: We examined infants who were born at gestational age below 32 weeks and followed in a neonatal intensive care unit of a tertiary center between January
2017 and August 2022 The neutrophil lymphocyte ratio, systemic immune inflammation index, systemic inflammation response index, and pan immune inflammation value were calculated from peripheral whole blood cell counts at birth and 72 hours for infants with BPD and without BPD.
Results: The study comprised a total of 118 infants, including 55 with BPD and, 63 without BPD. The monocyte count at 72 h was significantly lower and SII at the 72 h was significantly higher in the BPD group
Conclusion:Systemic inflammatory indices are practical, affordable, and easily available tools derived from serum whole blood cell counts that could be used for BPD early diagnosis and prevention.

Introduction
Healthy newborn required hypothermic treatment for HIE (Hypoxic Ischaemic Encephalopathy) in a level 1 Centre with umbilical cord gases which were not escalated due to metabolic alkalosis. Initial Umbilical cord gas PH 7.59, PCO2- 3.95, BE 7.5, HCO3- 31. As a routine practice, only metabolic acidosis is usually flagged for further management of HIE.

Case Report
In our case report we notify that a neonate born by SVD, vigorous and continued routine care. Later at 51 minutes of life she was found unresponsive and required resuscitation for 25 minutes. There were no antenatal risk factors was detected including sepsis. Capillary gas post resuscitation at 90min of age revealed mixed acidosis with PH 6.96, PO2 5.62, PCo2 10.44, BE-16.8., Lactate 8.76, HCo3 is 12.1 Baby was intubated and ventilated during resuscitation. Patient subsequently developed seizure where she had met the cooling criteria. She was transferred then to tertiary centre for hypothermic therapy. MRI and EEG post treatment were normal.

Discussion
From our case report we have concluded that it was a compensatory process for metabolic alkalosis by neonate was through respiratory mechanism which result in reduced breathing and collapse.
As HIE have significant morbidity and mortality, will this change our practice in the future? Should cord gas be routinely done than in the future to prevent rare causes as well? Our cases suggest that not only umbilical cord gas metabolic acidosis, but also metabolic alkalosis should not be ignored as this can prevent significant morbidity in newborn with early intervention.

Objective

Currently rates of neonatal mortality are highest in French-speaking African countries. The aim of this project is to increase uptake and accessibility of French resources for small and sick newborn care.

Methods 

The Implementation Toolkit for Small and Sick Newborn Care, created by NEST360 and UNICEF, brings together tools, readings, and learnings to provide a one-stop site for implementers to act, learn, and share. The Implementation Toolkit takes a systems approach to supporting small and sick newborn care through eight health systems building blocks. This includes infrastructure, infection prevention and control, information systems, leadership and governance, financing, family centered care, human resources, and medical supplies and devices.

Results

The Implementation Toolkit for Small and Sick Newborn Care now contains over 200 tools, readings, and learnings in French, a French-English glossary to support translation of technical terms, and online seminars led by experts in neonatal health topics across the eight health systems buildings blocks. The growing community of practice for SSNC in French contains academics, clinicians, researchers, funders, government officials, biomedical engineers.

Conclusion

Expanding access to resources is critical to ensuring that the Sustainable Development Goal 3.2 of reducing neonatal mortality to less than 12 per 1000 live births is achieved. Closing the implementation gap by providing resources in French is an essential first step. The Implementation Toolkit for Small and Sick Newborn Care, now in French, provides a novel systems-based approach to supporting this goal.

Title EARLY NEONATAL BIRTH RELATED TRAUMA OF THE HEAD AND NECK REGION
Introduction Early neonatal birth-related trauma can cause significant transient or permanent damage. This study helped us to identify the common types of head and neck trauma at our institution and their relationship to certain effect modifiers.
Objectives :To determine the frequency of types of birth trauma of the head and neck region in early neonates.
Materials & Methods :125 neonates of either gender presenting within seven days of birth with birth trauma of head and neck region fulfilling the selection criteria were included in study. Informed consent was taken from their parents/guardians before enrolling in the study. Demographic Data, types of trauma, gestational-age, birth-weight, maternal-age,mode of delivery, parity and untrained handling was documented by history, clinical examination, relevant investigations in Approved Performa. Data confidentiality was ensured. Data entered and analyzed using SPSS version 20.0.
Results 64 (51.2%) males and 61(48.8%) females were seen.Cephalhematoma was observed in 82(65.6%) followed By Scalp/Facial laceration 20(16%), Facial Nerve Injury 12(9.6%) And Clavicular Fracture 11(8.8%). Gestational-Age (p=0.003), Birth-Weight equal to or >2.6kg (p=0.005), Mode of delivery (p=0.000),Mother parity (p=0.001) and untrained handling (p=0.006) showed statistical significance in relation to birth trauma while gender and maternal age did not show any statistical significance.
Conclusion Most common birth related trauma observed in our study Was Cephalhematoma followed by Scalp/Facial Laceration, Facial Nerve Injury and Clavicular Fracture with statistically significant relationship seen with Gestational-Age, Birth-Weight (>2.6kg), Mode Of delivery, Mother’s parity (Multigravida) and Untrained handling.

Routine hearing screening has been recommended for all children before 3 months of age in the United States and Europe.
Objective :To assess the acceptability of screening for neonatal hearing loss by parents.
This is a prospective study spread over two months (February and March 2023), concerning 176 parents of newborns who benefited from neonatal screening for deafness in CHU Mohammed VI in Marrakech. Data collection was done through phone calls.
Results :76% of responders were mothers and 24% were fathers. The average age of the parents was 34 years [17, 45]. The geographical origin was rural in 69.4% of cases and urban in 31.7% . The socio-economic level was low in 65.4% and medium in 34.6%. The level of parental education was low (no schooling) in 33%, medium (schooled) in 61.4% and high (higher education) in 5.6%. Only 5 parents were aware of the possibility of screening for deafness in newborns and their source of information was the media. All parents would like screening to be generalized free of charge in Morocco. No one has any idea about the cost of screening, nor about the tolerance of the examination by newborns. The majority (82.4%) of parents surveyed say the test was simple and painless for their children.geographical accessibility, financial resources).
Conclusion: This study made it possible to raise the lack of information of the parents concerning the deafness of the child representing the most frequent neurosensory deficit in our context. She also showed acceptance and encouragement of her screening.

INTRODUCTION:
Serratia marcescens is a well-recognized cause of nosocomial outbreaks in pediatric population. These outbreaks have usually been linked to poor environmental disinfection and breach in infection prevention practices.

OBJECTIVE:
To identify the sources of a nosocomial outbreak of Serratia marcescens in pediatric ward, NICVD Karachi

METHODS:
Laboratory surveillance revealed an increase in Carbapenem resistant Serratia species bloodstream infections in September 2022. A case definition was finalized, data was collected and line listing was developed.

RESULTS:
A total of 20 Healthcare associated blood stream infections with CRE Serratia were identified from September- December 2022 from the Pediatric ward, of which 4 patients died. Outbreak investigation was done comprising of detailed infection prevention rounds, audits, environmental cultures, which revealed breach in practices of hand hygiene and environmental cleaning, reuse of open medication vials and suctioning machines, improper storage of medicines, overcrowding and bed sharing, overuse of antibiotics etc. A multidisciplinary approach was employed to overcome the outbreak concsisting of multiple bedside teaching sessions of nursing staff/doctors to improve infection prevention practices, of housekeeping staff to improve environmental cleaning and disinfection, increasing number of isolation rooms, implementing visitor control policy, minimizing bed sharing, frequent and thorough terminal cleaning of ward, ensuring availability of hand hygiene products and environmental cleaning supplies, exploring OPAT services for discharged patients. With execution of all above mentioned interventions, the outbreak is at a standstill since December and no new case has been reported since then.

CONCLUSION:
Adhering to infection control principles proved effective in terminating the outbreak

Background
Neonatal Abstinence Syndrome (NAS) is the set of symptoms that appear when intrauterine exposure to toxic substances is interrupted. Early diagnosis is key to prevent and treat symptoms.

Objective
The main objective in our work is to know the epidemiology and the clinical manifestations of the newborns admitted in our Department with the diagnosis of NAS.

Method
We did a retrospective study of the cases with diagnosis of NAS in a Neonatology Department of a Tertiary Referral Hospital in Europe between the years 2016-2021. We select obstetrics data (age of mother, pregnancy control, drugs consumed) and newborn data (gestational age, sex, associated diseases, length of hospital admission and treatment needed). We did a descriptive analysis of the variables.

Results
Out of the 18 cases in the selected years 64.7% were male and 61.1% were to term. Maternal age mean was 32.72 year. Between the drug consumption stand out methadone (34.3%) and other opioids (25.7%). The median of length hospital admission was 27 day. Only 2 neonates did not need to start morphine as substitutive. Infectious diseases were the predominant diseases associated with NAS.

Conclusion
NAS is a problem not only in the clinical but also in the social perspective. Early treatment and detection is need to provide a quality care. NAS need to be present in our differential diagnosis.

Objective/background:
• protocol for USG imaging for neonatologists.
• Assessing the progress of the neonate in routine clinic-radiological round.
• Utilization of Doppler to evaluate ICP, hydrocephalus & prognostic indicator of infarct.
• Validating clinical spectrum with imaging.

Methods & Materials:
• Prospective study of neonatal USG in NICU across multiple mother & child hospitals.
• Sample size of 500 neonates including preterm & term babies over a period of 1 year.
• Routine clinic-radiological rounds with neonatologists in the evaluation of neonates.
• USG includes cranium/abdomen/pelvis/hip joints/chest/neck extremities/doppler vessels.
• Majority cases were having NSG in preterm neonates with serial evaluation.

Results:
The new protocol has been set in the NICU unit for performing USG. Standardizing normal parameters during clinic-radiological round including the size of organs/RI of arterial Doppler etc. PVL/ICH/Early NEC is common finding in premes. Perforation/meconium ileus is commonly seen with NEC. RI index of anterior cerebral artery Doppler study is the best indicator of intracranial pressure in hydrocephalus. Chest USG is the best method for identifying minimal pneumonia/pneumonia in hidden areas of chest radiographs. The timing of eg:-study is fixed & followed over a period of time, for eg:- Hip USG/Renal pelvicalyceal dilatation of PUJ obstruction.

Conclusion:
1. Clinicoradiological rounds, essential & novel approach in the NICU.
2. Improved assessment of neonates with combined clinical & USG evaluation.
3. Eliminating discrepancies in clinical & radiological finding thus helping clinicians with better options.
4. New protocol & application for routine assessment of neonates with USG by clinician.

Introduction:
We present a case of a 29+1 gestation DCDA twin who sustained an iatrogenic bladder injury perforation following umbilical catheterisation.

Case:
A UVC was inserted on day 1. X-ray reavealed catheter was directed dorsally with tip at S1-2 suggesting that the catheter was in the umbilical artery rather than vein. It was pulled back to L4-5 and TPN commenced. This malposition was recognised later and catheter was removed.
Baby was transferred to NICU on day 2 due ventilatory requirement. On admission, baby's abdomen was mildly distended. The baby was extubated onto CPAP and trophic feeds commenced.
From day 4 there was increasing abdominal distension and oliguria. Abdominal xray and ultrasound revealed intra-abdominal ascites. There was no other biochemical/radiographic evidence of sepsis/NEC. Renal function deteriorated (Urea 18.2, Creatinine 172) and baby became anuric on day 8.
Baby was transferred to a surgical centre in view of ascites and worsening renal function. USS guided ascitic tap aspirated yellow fluid and cystogram revealed a bladder injury with clear extravasation of contrast into peritoneum.
Baby underwent surgical repair and made a full recovery.

Discussion:
Umbilical artery catheterisation can result in a perforation injury of the bladder or urachal ramnant with subsequent extravasation of urine into the peritoneal cavity. It can result in azotaemia, ascites and anuria.

Conclusion:
Although rare, neonatologists and surgeons need to be aware of this presentation as it requires prompt repair. Cystogram with contrast is recommended for increasing abdominal distention without signs of NEC with a history of umbilical catheterisation.

Background:
Babies born before term (less than 37 weeks of gestation) are termed as ‘pre-term babies’.In addition to the long-term post-birth complications, there are certain immediate dangers associated with prematurity such as breathing problems, enterocolitis,and heart issues. One of the most common short-term complications is hypothermia, or low body temperature. Prompt use of plastic/polythene bags, skin-to-skin care (SSC), transwarmer mattress, warming hats and transport incubator can significantly reduce the near fatal consequences of hypothermia.

Objective:
This narrative review aims to shed light on the benefits and risks associated with the use of plastic bags in the management of hypothermia in pre-term infants.

Methods:
The studies reported in this review were collected from the databases that include PubMed, Sciencedirect, Hindawi, Nature and JAMA in the period of 2009-2023. The keywords used in this study were prematurity,infants, hypothermia, temperature and plastic bags. The articles that emphasized only on the use and benefits of plastic bags for babies were included, and the studies that focused on temperature control for babies using other traditional or modern techniques were excluded.

Results:
Literature review showed that the use of plastic bag wrapping technique is one of the most efficacious mode of management of hypothermia in pre-term infants.

Conclusion:
This review article aims to educate the healthcare providers, especially hailing from the rural areas regarding this cost-effective method for managing in-hospital hypothermia among premature babies. This would prove helpful to hospital professionals and midwives from remote areas, who do not have the access to high-performance medical equipment.

Background:
Congenital hypopituitarism is characterized by a deficiency of one or more pituitary hormones with a rare incidence; 1 in 4,000–1 in 10,000 live births.

Objective: Early diagnosis and treatment may prevent impairment of cognitive function, poor growth and alterations in metabolic profile.

Results
We present a male, born to a healthy primigravid woman by vaginal delivery. His birth weight was 2.6 kg, and noticed micropenis with retractile testis. At 8 hours of life, presented symptomatic hypoglycemia (6.2 mg/dL), jaundice (unconjugated bilirubin: 10mg/dL) and low insulin levels (0.2 mcU/mL). Improving with phototherapy and glucose infusión for 72 hours. The persistent hypoglycemia, prolonged jaundice, hypoinsulinism and micropenis suggested Growth Hormone (GH) deficiency. GH produces a rise in plasma levels responding to hypoglycemia. The screening determined low GH (2.4 ng/mL), and low insulin-like growth factor of 30 ug/L, confirming GH deficiency. Coexistence with low random cortisol (1.2 mcg/dL) suspected a pituitary disorder, which assessement showed normal 17-OHP levels, undetectable luteinizing and follicle-stimulating hormone levels, low testosterone (< 0.1 nmol/L), and hyperprolactinemia (hypogonadotropic hypogonadism). Also, low T4 and normal TSH level suggested a diagnosis of central hypothyroidism. A brain MRI showed complete absence of the septum pellucidum and corpus callosum hypoplasia. This multiple pituitary hormone deficits lead to Congenital Hypopituitarism diagnosis, with targeted genetic study pending. Treatment involved steroids and hormone replacement.

Conclusions
The pituitary gland is a central regulator of growth, metabolism, and reproduction. To avoid needless morbidity and mortality, early identification of hypopituitarism and proper hormone replacement therapy are crucial.

Background:
Prematurity is cause of perinatal mortality and morbidity. Mortality is higher in newborns under 32 weeks.

Objective:
To determine factors associated with preterm mortality

Methods:
A retrospective study was conducted at Monkole Hospital on date base of preterm babies, born during the period from January, 2018 to December, 2021.

Results:
398 hospitalised preterms were included. The prevalence of prematurity was 8.3%, with 220 (55.6%) female and 176 (44.4%) male, a sex ratio of 1.25. Their average weight was 1482 + 434 g. Caesarean section in 47% (186). Central cyanosis was present in 32.1% (127), the majority was less than 28 weeks. The rate of antenatal steroid use was 45% (75/167). Mortality rate was higher in preterm infants less than 28 weeks. The rate was 80.1% in breterms 26 weeks, 69.1% at 27 weeks and 56.5% at 28 weeks. A multivariate logistic regression analysis noted that the mortality of preterm infants decreased with increasing gestational age (OR= 0.544, 95% CI: 0.450-0.659, p=0.000). Morbidity was associated with the absence of antenatal corticosteroid therapy (OR = 2.768, 95% CI: 1.071-7154, p=0.036), absence of Continuous Positive Airway Pressure CPAP use (OR= 0.259, 95% CI: 0.109-0.619, p=0.002) and with transfer (OR = 0.338, 95% CI: 1.470-5.534, p = 0.002).

Conclusions:
Prematurity is one of the major causes of neonatal mortality especially in developing countries. The absence of antenatal corticosteroid therapy and non-use of CPAP increases the mortality of premature babies in this study.

Key words: Prematurity , mortality, antenatal corticosteroid, CPAP

Background

Although Small and Sick Newborn Care (SSNC) now has an ENAP coverage target, increasing national and global attention, as well as new WHO standards, much of the evidence is hard to find due to a major gap in “how to” implement, especially across varying contexts. To deliver and scale the multiple interventions needed for special and intensive care, we need to go beyond a single intervention at a time and adopt a whole health systems approach. This toolkit addresses the implementation gap by being the go-to place for knowledge and evidence, practical tools, and implementation experiences to accelerate progress for newborn survival.

Methods

The Toolkit is co-designed by UNICEF and NEST360 with contributions from a growing community of over 300 implementers across 52 countries to be a one-stop site to act, share and learn and organised by the WHO health system building blocks.

Results

This toolkit hosts WHO guidelines, norms and standards, and other relevant resources for implementation. It is an online, open-sourced platform with over 700 tools, readings and resources. It has a newsletter subscriber membership of over 300 and a cumulative webinar viewership of over 1000 attendees. The website has a growing user base with regular users from India, Nigeria, Kenya, with an estimated 52000 impressions online in the first quarter of 2023.

Conclusion

The Newborn Toolkit is building a SSNC Community of Practice (CoP). Further information on how attendees can join and get involved in the growing global SSNC CoP will be provided.