Developing and implementing a health educational package for preemie moms in the care of their baby after hospital discharge.

INTRODUCTION: Educating a mother of a premature baby and providing a structured written educational information can enhance better understanding and practice. This article describes the development and implementation of a health educational package for preemie moms in the care of their premature baby after neonatal intensive care unit discharge. SUBJECTS AND METHODS: The package known as "Preemie Mom: A Guide for You" was designed based on Stufflebeam's model and has four phases: (1) content evaluation from available sources of information, (2) input evaluation based on mothers' need related to premature baby care, (3) process evaluation for package designing and content drafting, and (4) product evaluation to determine its feasibility. The contents were extracted and collated for validation by consulting various specialists in related fields. A final draft was drawn based on comments given by experts. Comments from the mothers were taken for formatting, visual appearance, and content flow for easy understanding and usage. RESULTS: All ten existing articles and eight relevant documents were gathered and critically appraised. The package was designed based on 11 main components related to the care of premature baby after discharge. The content validation was accepted at a minimum score of 0.85 for the item-level content validity index analysis. Both experts and mothers were agreed that the package is easy to use and well accepted as a guide after discharge. The agreement rate by the mothers was at 93.33% and greater for the front page, writing style, structure, presentation, and motives of the package. CONCLUSIONS: "Preemie Mom: A Guide for You" is a validated health educational package and ready to be used to meet the needs of the mother for premature baby care at home.

Neonatal hypoxic encephalopathy: Correlation between post-cooling brain MRI findings and 2 years neurodevelopmental outcome.

OBJECTIVE: This study aims to evaluate the magnetic resonance imaging (MRI) brain patterns among hypoxic-ischemic encephalopathy (HIE) babies who underwent post-cooling MRI brain as well as to correlate the post-cooling brain scoring with patient's neurodevelopmental outcome at 2 years. SUBJECTS AND METHODS: It was a retrospective cross sectional study carried out at a tertiary university hospital. Record of patients diagnosed with neonatal HIE from 2007 until 2016 who completed 72 h of cooling therapy and had MRI brain within 2 weeks of life were included in this study. A new scoring system by Trivedi et al. that emphasizes on subcortical deep gray matter and posterior limb internal capsule injury were utilized upon MRI assessment, using TW, T2W, and diffusion-weighted imaging (DWI) sequences. Cumulative MRI brain score was obtained and graded as none, mild, moderate, and severe brain injury. The MRI brain scoring was then correlated with patient's 2 years neurodevelopmental outcome using Fisher's Exact Test. RESULTS: A total of 23 patients were eligible of which 19 term neonates were included. 13% of these neonates (n = 3) had mild MRI brain injury grading with 52.2% (n = 12) moderate and 34.8% (n = 8) severe. There was no significant correlation seen between MRI brain grading and developmental outcome at 2 years old (P > 0.05). CONCLUSION: There was no significant correlation between neonatal MRI brain injury grading and 2 years neurodevelopmental outcome. Nevertheless, the new MRI brain scoring by Trivedi et al. is reproducible and comprehensive as it involves various important brain structures, assessed from different MRI sequences.

Neonatal pain: Knowledge and perception among pediatric doctors in Malaysia.

BACKGROUND: Inadequate pain management is linked to potential neurodevelopmental and behavioral problems. Sufficient knowledge in neonatal pain is required to facilitate optimal pain management. The aim of this study was therefore to assess the knowledge and perception of pain experienced by neonates requiring intensive care among pediatric doctors working in a level III neonatal intensive care unit in Malaysian hospitals. METHODS: This was a cross-sectional study conducted over a period of 18 months. A self-administered questionnaire assessing knowledge and perception regarding neonatal pain was used. RESULTS: Twenty-four hospitals participated in the study, with 423 respondents. The response rate was 85%. One hundred and ninety-seven respondents (47%) were aware of tools for neonatal pain assessment, but only 6% used them in daily practice. Doctors with >4 years of experience in neonatal care had better awareness of available pain assessment tools (59.4% vs 40.9%, P = 0.001). Sixteen statements regarding knowledge were assessed. Mean score obtained was 10.5 ± 2.5. Consultants/specialists obtained a higher mean score than medical officers (11.9 vs 10.4, P < 0.001). More than 80% of respondents were able to discriminate painful from non-painful procedures. CONCLUSION: Clinicians involved in neonatal care, especially those with longer experience were knowledgeable about neonatal pain. Gaps between knowledge and its application, however, remain. Implementation of clinical guidelines to improve the quality of assessment and adequate pain management in neonates is recommended.

Does palm oil vitamin E reduce the risk of pregnancy induced hypertension?

In view of the high anti-oxidative potential oftocotrienol, the role of the tocotrienol-rich fraction (TRF) of palm oil in preventing pregnancy induced hypertension (PIH) was explored in a randomized double-blind placebo-controlled clinical trial in an urban teaching hospital. Healthy primigravidae were randomized to receive either oral TRF 100 mg daily or placebo, from early second trimester until delivery. Out of 299 women, 151 were randomized into the TRF arm and 148 into the placebo arm. A total of 15 (5.0%) developed PIH. Although there was no statistically significant difference in the incidence of PIH (4/151 or 2.6% in the TRF arm vs. 11/148 or 7.4% in the placebo arm, p = 0.058) between the two arms, there was a tendency towards a lower incidence of PIH in the TRF arm compared to the placebo arm. With TRF supplementation, the relative risk (RR) of PIH was 0.36 (95% CI 0.12-1.09). In conclusion, although TRF from palm oil does not statistically significantly reduce the risk of development of PIH in the population studied, the 64% reduction in incidence of PIH is substantial. The findings warrant further clinical trials, particularly in high risk populations.

Kiwi Omnicup versus Malmstrom metal cup in vacuum assisted delivery: a randomized comparative trial.

AIM: To compare the success, clinical outcomes, and maternal and neonatal complications between the Kiwi Omnicup and the Malmstrom metal cup in vacuum assisted delivery. METHODS: This was a prospective randomized comparative trial. Women who required vacuum assisted vaginal delivery were randomized into the Kiwi Omnicup (KO) group and the Malmstrom metal cup (MM) group. The vacuum assisted deliveries were conducted according to hospital protocol. Details of the procedure and delivery outcomes including success and complications were analyzed. RESULTS: One hundred and sixty-four women were recruited - 85 were assigned to vacuum assisted delivery using the KO and 79 the MM. One hundred percent delivery success was achieved with no significant differences between the two instruments in terms of maternal morbidity (P = 0.66). Six women in the MM group sustained post delivery complications in comparison to five in the KO group. Three babies were diagnosed with birth asphyxia in each group. More babies in the MM group were admitted to the Neonatal Intensive Care Unit (NICU) (10 babies versus 5 babies) and suffered complications (14 versus 12 babies), compared to the KO group, although the difference was not statistically significant. There were no intrapartum or neonatal deaths and of those admitted to the NICU, all were discharged within a week without any serious consequences. CONCLUSION: Kiwi Omnicup is an effective alternative to the currently available Malmstrom metal cup for vacuum assisted delivery with no increase in maternal or neonatal morbidity or mortality.

Mother with post-partum group B Streptococcus meningitis and cerebellar abscess.

We report the case of a 25-year-old Malay woman, admitted for preterm delivery at 35 weeks' gestation. Vaginal swab did not isolate any organism. She delivered a baby girl who developed respiratory distress syndrome, requiring ventilation. Although chest radiograph showed hyaline membrane disease with pneumonia, septic workout was negative. The mother was discharged on the next day. Seven days postpartum, the mother presented with fever and fits and was diagnosed to have meningo-encephalitis. Lumbar puncture isolated group B Streptococcus (GBS) and MRI revealed a superior cerebellar abscess. She was treated and survived the episode. This case illustrates the uncommon situation where GBS infection was confirmed via maternal septic workout rather than neonatal, although both presented with severe disease.

Risk factors associated with subaponeurotic haemorrhage in full-term infants exposed to vacuum extraction.

OBJECTIVES: To determine obstetric and neonatal risk factors associated with subaponeurotic haemorrhage (SAH) in infants exposed to vacuum extraction. DESIGN: A prospective observational study. SETTING: In the labour room, operation theatre, postnatal wards and neonatal intensive care unit (NICU) of a tertiary teaching hospital. POPULATION: All infants born in the hospital with a history of exposure to vacuum extraction. METHODS: A prospective observational study carried out over a 26-month period. All eligible infants were examined at birth and during the first 24 hours of life. MAIN OUTCOME MEASURES: A diagnosis of SAH was based on detection of a tender fluctuant scalp swelling that crossed the skull suture lines of infants. RESULTS: Of 10,066 infants born in the hospital during the study period, 338 (3.4%) had exposure to vacuum extraction. SAH was detected in 71 (21.0%) of them. Forward multivariate logistic regression analysis showed that five factors were significantly associated with development of SAH: maternal nulliparity (adjusted odds ratio [OR]: 4.0; 95% confidence intervals [CI]: 1.6, 10.0), failed vacuum extraction (adjusted OR: 16.4; 95% CI: 2.0, 135.6), Apgar score of less than 8 at 5 minutes of life (adjusted OR: 5.0; 95% CI: 1.7, 15.2), marks of vacuum cup over the sagittal suture (adjusted OR: 4.4; 95% CI: 1.9, 10.2) and marks of leading edge of vacuum cup at <3 cm away from the anterior fontanel of infants' heads (adjusted OR: 6.0; 95% CI: 1.7, 21.0). CONCLUSION: Maternal nulliparity, placement of vacuum extraction cup over the sagittal suture at a distance too close to infant's anterior fontanel and failed vacuum extraction predisposed infants to develop SAH.