Extended Perinatal Mortality Audit in a Rural Hospital in India.

OBJECTIVE: The aim of the study is to describe the status of perinatal mortality (PM) in an Indian rural hospital. STUDY DESIGN: Retrospective analysis of data was compiled from PM meetings (April 2017 to December 2018) following "Making Every Baby Count: audit and review of stillbirths and neonatal deaths (ENAP or Every Newborn Action Plan)." RESULTS: The study includes 8,801 livebirths, 105 stillbirths (SBs); 74 antepartum stillbirths [ASBs], 22 intrapartum stillbirths [ISBs], and nine unknown timing stillbirths [USBs]), 39 neonatal deaths or NDs (perinatal death or PDs 144). The higher risks for ASBs were maternal age >34 years, previous history of death, and/or SBs. Almost half of the PDs could be related with antepartum complications. More than half of the ASB were related with preeclampsia/eclampsia and abruptio placentae; one-third of the ISB were related with preeclampsia/eclampsia and gestational hypertension, fetal growth restriction, and placental dysfunction. The main maternal conditions differed between PDs (p = 0.005). The main causes of the ND were infections, congenital malformations, complications of prematurity, intrapartum complications, and unknown. The stillbirth rate was 11.8/1,000 births, neonatal mortality rate 4.4/1,000 livebirths, and perinatal mortality rate 15.8/1,000 births. CONCLUSION: This is the first study of its kind in Andhra Pradesh being the first step for the analysis and prevention of PM. KEY POINTS: · Many conditions that lead to stillbirths are linked to neonatal deaths and PM has been outside of the global parameters from the last decades.. · This is the first study following International Classification of Disease perinatal mortality codes and the audit of ENAP in Andhra Pradesh.. · Extended PM and mortality are mainly caused by similar preventable and treatable conditions..

Challenges in the application of non-servocontrolled therapeutic hypothermia during neonatal transport in Catalonia.

INTRODUCTION: Therapeutic hypothermia (TH) improves survival and neurological prognosis in hypoxic-ischemic encephalopathic (HIE) babies, being better the sooner TH is implemented. HIE babies are born more frequently in a non-cooling centre and need to be referred. METHODS: Prospective-observational study (April 18 2018 - November 19 2019). Newborns (≥34 weeks of gestational age (GA) and >1800 g) with moderate/severe HIE on non-servocontrolled therapeutic hypothermia by the two neonatal transport teams in Catalonia. RESULTS: 51 newborns. The median stabilisation and transport time were 68 min (p25-75, 45-85 min) and 30 min (p25-75, 15-45 min), respectively. The mean age at arrival at the receiving unit was 4 h and 18 min (SD 96.6). The incubator was set off in 43 (84%), iced-packs 11 (21.5%) and both (11, 21.5%). Target temperature was reached in 19 (37.3%) babies. There were no differences in the overcooling in relation to the measures applied. The transport duration was not related with temperature stabilisation or target temperature reachiness. CONCLUSIONS: Rectal temperature monitorisation is compulsory for the stabilisation and the application of non-servocontrolled hypothermia during transport. There is still time for improving in the administration of this treatment during transport. Servo-controlled hypothermia would be a better alternative to improve the management of HIE babies.

[Challenges in the application of non-servocontrolled therapeutic hypothermia during neonatal transport in Catalonia]. / Retos en la aplicación de la hipotermia terapéutica no servo-controlada durante el transporte neonatal en Cataluña.

INTRODUCTION: Therapeutic hypothermia (TH) improves survival and neurological prognosis in hypoxic-ischemic encephalopathic (HIE) babies, being better the sooner TH is implemented. HIE babies are born more frequently in a non-cooling centre and need to be referred. METHODS: Prospective-observational study (April 18-November 19). Newborns (≥34 weeks of gestational age (GA) and >1800g) with moderate/severe HIE on non-servocontrolled therapeutic hypothermia by the two neonatal transport teams in Catalonia. RESULTS: 51 newborns. The median stabilisation and transport time were 68min (p25-75, 45-85min) and 30min (p25-75, 15-45min), respectively. The mean age at arrival at the receiving unit was 4h and 18min (SD 96.6). The incubator was set off in 43 (84%), iced-packs 11 (21.5%) and both (11, 21.5%). Target temperature was reached in 19 (37.3%) babies. There was no differences in the overcooling in relation to the measures applied. The transport duration was not related with temperature stabilisation or target temperature reachiness. CONCLUSIONS: Rectal temperature monitorisation is compulsory for the stabilisation and the application of non-servocontrolled hypothermia during transport. There is still time for improving in the administration of this treatment during transport. Servo-controlled hypothermia would be a better alternative to improve the management of HIE babies.

Servo-controlled cooling during neonatal transport for babies with hypoxic-ischaemic encephalopathy is practical and beneficial: Experience from a large UK neonatal transport service.

AIM: Servo-controlled therapeutic hypothermia is a routine therapy for babies with hypoxic-ischaemic encephalopathy in the neonatal unit and is delivered in designated cooling centres. It is increasingly being used during neonatal transport in the UK to deliver this therapy in a timelier manner for babies not born in a cooling centre. Prior to the implementation of this treatment, passive cooling alone was used in transport. Comparison of passive and servo-controlled cooling during neonatal transfers with reference to: (i) the proportion of babies in the therapeutic range (33-34°C) at three time points during the transport mission (arrival of the team at the referring unit, departure of the team from the referring unit and at the completion of transport); (ii) the proportion of babies overcooled at any point once the transport team was present (<33°C); and (iii) duration of phases of the transfer to evaluate the impact of active cooling on how long it takes to undertake transfer. METHODS: This was a retrospective observational study comparing babies with passive and servo-controlled hypothermia (January 2015 to May 2016) following introduction of the servo-controlled cooling mattress. RESULTS: A total of 48 patients were treated with hypothermia in transit (29 passive, 19 servo-controlled). The median gestational age (GA) was 40 weeks (interquartile range: 39-41) and mean birthweight (BW) 3420 g (standard deviation 600 g); there was no differences in GA, BW and clinical characteristics between the groups. There was a statistically significant difference in the temperature at the end of the transport, where 94% (n = 18) of babies who received servo-controlled cooling were in the target temperature in comparison with only 65% (n = 19) of the passive cooling group babies (P = 0.045). In addition, none of the babies in the servo-controlled group were warm (>34°C) at the end of the transfer. Babies who underwent servo-controlled cooling are more likely to maintain a target temperature (33-34°C) (17 (89%) vs. 17 (58%), P = 0.021); in particular, there is less overcooling (<33°C) in this group (2 (10%) vs. 15 (51%), P = 0.004). Total mission time was not significantly different. CONCLUSION: The use of servo-controlled cooling devices during neonatal transport improves the ability to maintain the baby's temperature within the target range (33-34°C) with less overcooling.