Evaluation of the impact of continuous Kangaroo Mother Care (KMC) initiated immediately after birth compared to KMC initiated after stabilization in newborns with birth weight 1.0 to < 1.8 kg on neurodevelopmental outcomes: Protocol for a follow-up study.

BACKGROUND: Preterm birth or low birth weight is the single largest cause of death in newborns, however this mortality can be reduced through newborn care interventions, including Kangaroo Mother Care (KMC). Previously, a multi-country randomized controlled trial, coordinated by the World Health Organization (WHO), reported a significant survival advantage with initiation of continuous KMC immediately after birth compared with initiation of continuous KMC a few days after birth when the baby is considered clinically stable. Whether the survival advantage would lead to higher rates of neurodevelopmental morbidities, or the immediate KMC will also have a beneficial effect on cognitive development also, has not been investigated. We therefore propose to test the hypothesis that low-birth-weight infants exposed to immediate KMC will have lower rates of neurodevelopmental impairment in comparison to traditional KMC-treated infants, by prospectively following up infants already enrolled in the immediate KMC trial for the first 2 years of life, and assessing their growth and neurodevelopment. METHODS: This prospective cohort study will enroll surviving neonates from the main WHO immediate KMC trial. The main trial as well as this follow-up study are being conducted in five low- and middle-income countries in South Asia and sub-Saharan Africa. The estimated sample size for comparison of the risk of neurodevelopmental impairment is a total of 2200 children. The primary outcome will include rates of cerebral palsy, hearing impairment, vision impairment, mental and motor development, and epilepsy and will be assessed by the age of 3 years. The analysis will be by intention to treat. DISCUSSION: Immediate KMC can potentially reduce low-birth-weight-associated complications such as respiratory disease, hypothermia, hypoglycemia, and infection that can result in impaired neurocognitive development. Neuroprotection may also be mediated by improved physiological stabilization that may lead to better maturation of neural pathways, reduced risk of hypoxia, positive parental impact, improved sleep cycles, and improved stress responses. The present study will help in evaluating the overall impact of KMC by investigating the long-term effect on neurodevelopmental impairment in the survivors. TRIAL REGISTRATION: Clinical Trials Registry-India CTRI/2019/11/021899. Registered on 06 November 2019. Trials registration of parent trial: ACTRN12618001880235; Clinical Trials Registry-India: CTRI/2018/08/015369.

Childhood poisoning at the Queen Elizabeth Central Hospital, Blantyre, Malawi.

OBJECTIVES: To record the number of children with poisoning admitted to the Queen Elizabeth Central Hospital over one year; to note the causes, clinical and laboratory findings and outcome of each poisoning event and; to highlight any preventable pattern in such events. DESIGN: A one year prospective study was undertaken of all children admitted to the Queen Elizabeth Central Hospital with a history or clinical evidence of acute poisoning. Socio-demographic, clinical and laboratory data were recorded and outcome noted for each child on specially prepared forms. Data were entered and then analysed in Epi-Info 6. SETTING: Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi. INTERVENTIONS: Children were treated forpoisoning according to national guidelines; supportive care and active antidote were given as necessary. MAIN OUTCOME MEASURES: Length of stay in hospital and mortality were primary outcome measures. RESULTS: One hundred and forty four cases were admitted, 118 (82%) were accidental, in 19 cases the reason was unknown and six (4.2%) were non accidental. Carbonate poisoning caused 32% (n=46) of admissions and paraffin 16.7% (n=24). The age range of poisoned children was three weeks to 14 years with a mean of four years and eight months. Eleven deaths occurred, six of which were due to traditional medicine intoxication. CONCLUSION: Most poisoning were preventable and the public needs to be made aware of the dangers of household agents, advised how to store them in the home and what to do if a child ingests a poisonous substance. Traditional medicines are particularly dangerous to give to infants less than one year old and carry a high mortality.