Study on outcome of guided newborn care in postnatal ward and common practices of newborn care among mothers followed in outpatient department at Hi-Tech medical college and hospital, Bhubaneswar
Keywords:Guidance, Care, Neonate, Feeding, EONS, Danger signs
Background: Neonatal period is the most vulnerable phase in a child's life. The aim and goal of newborn care is not only to reduce neonatal mortality but more importantly to ensure their survival to the fullest. The neonatal mortality rate of India is 22 per 1000 live births. The neonatal period is only for 28 days yet it accounts for significant deaths under 5 years of age. Newborn morbidity and mortality contribute significantly to the infant mortality and under-five mortality rates in developing countries. About two-thirds of all infant deaths and 38% of all under-five deaths occur during the neonatal period, resulting in about 4 million neonatal deaths globally per year. Infant and under-five mortality ratio in developing countries have declined significantly in the past couple of decades, yet neonatal mortality rates have remained relatively static. The objective of this study was to understand the outcome of guided newborn care along with the patterns and determinants of essential newborn care and practices.
Methods: A prospective cohort study was done among new borns in the postnatal ward and the outpatient (OPD) based new borns at HMCH Bhubaneswar from July 2020 to June 2021. The mothers in the postnatal ward were taught cord care, skin care, optimal thermal care and neonatal feeding practices. The regular follow-up was done maximum up to 7 days. New born who came to OPD were evaluated on perspective of essential new born care and practices, followed by their mothers at home. A questionnaire was formulated for the OPD based patients to be answered before and after guidance.
Results: 100 early neonates were taken (N=50 from postnatal ward and N=50 from OPD). Out of 50 neonates in the postnatal ward. 4 (8%) had abdominal colic, 10 (20%) had skin rashes, 2 (4%) had fever, 5 (10%) had feeding issues and 9 (18%) had neonatal hyperbilirubinemia respectively. In OPD neonates 3 (6%) were diagnosed with early onset neonatal sepsis (EONS), 7 (14%) had refusal to feed, 12 (24%) had skin rashes, 5 (10%) had abdominal colic, 14 (28%) were applying coconut oil and 7 (14%) developed hyperbilirubinemia. Whereas in OPD 5 (10%) neonates needed admission NICU and rest were managed symptomatically.
Conclusions: New born care education and guidance helped in reduction of EONS, in gaining appropriate weight, in delivering optimal thermal care, practicing healthy skin care and implementing proper feeding techniques. All mothers need proper counselling and guidance in essential new born care.
Hindawi. Patterns and Determinants of Essential Newborn Care Practices in Rural Areas of Northern Ghana, 2014. Available at: https://www.hindawi.com/journals/ijpr/2014/40438. Accessed on 02 July 2021.
Degefie T, Amare Y, Mulligan B. Local understandings of care during delivery and postnatal period to inform home based package of newborn care interventions in rural Ethiopia: a qualitative study. BMC Int Health Hum Rights. 2014;14:17.
Prost A, Colbourn T, Seward N, Azad K, Coomarasamy A, Copas A, et al. Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis. Lancet. 2013;381(9879):1736-46.
Yadav A. Learning’s from community and home-based newborn care experiences of India for strengthening Rajasthan’s Community Level Newborn interventions, 2015. Available at: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/234/454. Accessed on 02 July 2021.
Hansen A, Eichenwald EC, Stark AR, Martin CR, Hansen AR. Cloherty and Stark's Manual of Neonatal Care. 8th ed. Wolters Kluwer Health; 2016.
Nyampong J, Udofia EA. Assessment of knowledge and quality of essential newborn care practices in La Dade Kotopon Municipality, Ghana. PLoS One. 2020;15(8):237820.
Mugadza G, Zvinavashe M, Gumbo FZ, Pedersen BS. Early breastfeeding initiation and incidence of neonatal sepsis in Chipinge District Zimbabwe. Int J Contemp Pediatr. 2018;5:1-5.
Smith ER, Hurt L, Chowdhury R, Sinha B, Fawzi W, Edmond KM, et al. Delayed breastfeeding initiation and infant survival: A systematic review and meta-analysis. PLoS One. 2017;12(7):180722.
Saaka M, Ali F, Vuu F. Prevalence and determinants of essential newborn care practices in the Lawra District of Ghana. BMC Pediatr. 2018;18(1):173.
Laryea C, Dickson KE, Moxon SG, Kapeu A, Nyange C, Niermeyer S, Begin F, et al. Basic newborn care and neonatal resuscitation: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy Childbirth. 2015;15(2):4.
Amsalu R, Morris CN, Hynes M, Had HJ, Seriki JA, Meehan K, et al. Effectiveness of clinical training on improving essential newborn care practices in Bossaso, Somalia: a pre and postintervention study. BMC Pediatr. 2020;20(1):215.