NEONATAL CARE Edited by Deborah Raines and Zoe Iliodromiti Neonatal Care Edited by Deborah Raines and Zoe Iliodromiti Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Marija Radja Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published August, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Neonatal Care, Edited by Deborah Raines and Zoe Iliodromiti p. cm. ISBN 978-953-51-0692-0 Contents Preface VII Chapter 1 Maternal Socio-Economic Status and Childhood Birth Weight: A Health Survey in Ghana 1 Edward Nketiah-Amponsah, Aaron Abuosi and Eric Arthur Chapter 2 Improving Newborn Interventions in Sub-Saharan Africa – Evaluating the Implementation Context in Uganda 19 Peter Waiswa Chapter 3 Recent Advances in Neonatal Gastroenterology and Neonatal Nutrition 39 Shripad Rao, Madhur Ravikumara, Gemma McLeod and Karen Simmer Chapter 4 Brain Injury in Preterm Infants 73 Zoe Iliodromiti, Dimitrios Zygouris, Paraskevi Karagianni, Panagiotis Belitsos, Angelos Daniilidis and Nikolaos Vrachnis Chapter 5 Parenchymatous Brain Injury in Premature Infants: Intraventricular Hemorrhage and Periventricular Leukomalacia 87 Mauricio Barría and Ana Flández Chapter 6 Association of Meconium Stained Amniotic Fluid with Fetal and Neonatal Brain Injury 103 Zoe Iliodromiti, Charalampos Grigoriadis, Nikolaos Vrachnis, Charalampos Siristatidis, Michail Varras and Georgios Creatsas Chapter 7 Sleep Development and Apnea in Newborns 115 Adrián Poblano and Reyes Haro Preface Neonatology is evolving rapidly and finds itself today at the forefront of numerous developments. The aim of this book is to present updated clinical and experimental data in the area of Νeonatology. The articles of this volume have been expressly included with the aim of deepening scientific understanding of the pathogenetic mechanisms implicated in neonatal disorders and of further motivating research by acquainting the reader with the current knowledge and future perspectives. The field of Neonatology is especially exacting given that the wishes and expectations of parents are very specific. This multi-author book includes seven Chapters embracing a particularly interesting selection of neonatal issues. We thus believe that it will be of considerable value to all healthcare professionals working within Neonatology, from the undergraduate medical student to the specialist doctor trainee, the senior neonatologist and the specialist nurse. Chapter 1 of this book offers, with the use of logistic and ordered logistic regression models, a highly informative epidemiological study analyzing the association between low birthweight, one of the key reproductive health indicators, and multiple factors such as the geographical area of residence, the gender of the child, multiple births, the age and the educational status of the mother. A notable finding has been that mothers who had secondary education or higher were significantly and inversely associated with having babies of low birthweight. Additional essential information is presented in the study in Chapter 2 in which the main principles of an effective, evidence-based newborn care program are detailed. Delays in recognition of perinatal problems and in the decision to seek care for these problems, or tardiness in reaching a health facility that has the opportunity to offer quality care are discussed as they can lead to increased perinatal morbidity and mortality rates. The third Chapter examines the effect of aggressive parenteral nutrition, defined as relatively high amounts of parenteral protein and lipid commencing on the first day of life in the occurrence of ex-utero growth retardation and associated morbidities. Also discussed are new effective therapies for necrotizing enterocolitis, short-gut syndrome, gastroschisis and neonatal hemochromatosis based on the synchronous principles of Neonatal Gastroenterology and Nutrition Care. In Chapter 4 the controversial issue of the potential pathogenetic mechanisms of brain injury in preterm infants as well as the pathological aspects of this condition are VIII Preface presented. This Chapter moreover includes short discussion about recent research studies which seek to develop therapies targeting astrocytes, activated microglia and glutamate inhibition. The following article, Chapter 5, analyzes two of the most common manifestations of brain injury in premature infants: periventricular leukomalacia and intraventricular hemorrhage. Additionally, the results of an original prospective cohort study in Chile analyzing the pathologic findings in cases of brain injury in neonates of 32 weeks or less (or birth weight of 1500 or less) are presented. Chapter 6 examines the association between meconium stained amniotic fluid—in both term and premature infants—and fetal brain injury that could lead to an adverse neurodevelopmental outcome. The potential pathogenetic pathways of brain injury due to meconium stained amniotic fluid are analyzed, as it appears evident that fetal- neonatal brain injury is the common origin for severe neurological handicaps, such as cerebral palsy and mental retardation, usually diagnosed years after birth and more frequently in children born through meconium stained amniotic fluid. Finally, Chapter 7 deals with one of the major problems in neonatal care, the presence of sleep apnea in premature infants. The main clinical features of apnea for its clinical diagnosis and therapy are analyzed, in combination with an interesting presentation of the process of sleep development from fetal to neonatal age, with the focus on respiratory alterations, such as apnea. I would like to extend my warm thanks to the authors who kindly agreed to make important contributions to this book and also to convey my gratitude to them for expending so much time and endeavor to do so. I additionally cordially thank the team at InTech for their most valuable expert assistance in the creation of this work. Last but certainly not least, the other authors and I express our sincere hope that this book will fully satisfy and fulfill our readers’ expectations and needs. Zoe Iliodromiti, MD Lecturer in Pediatrics and Neonatology University of Athens Medical School Aretaieio Hospital Athens Greece [...]... intra-partum care, and postnatal care for the mother and the baby, and to home visits by a volunteer to promote improved care during pregnancy, delivery and in the postnatal period Participants were asked to present their own experiences and actions, or otherwise to describe general attitudes 2.3.2 Care of preterm babies In order to understand the perceptions and care of preterm babies at home and at health... of the evidence-based newborn practices, and it helped to inform the design of the variables that assessed uptake of newborn care practices among babies who survived the 22 Neonatal Care neonatal period Finally, the picture was completed by seeking to understand the care provided to preterm babies at home and in health facilities as an example of the current care for newborn babies in the study area... current uptake of neonatal interventions including the quality of newborn care gaps across the maternal and newborn care continuum In this paper, I assess the implementation context for evidence-based newborn interventions, namely, primary health care health facilities, households/communities, and the linkages there of in the continuum for maternal and newborn care in terms of time and place), in order... illness and the need to seek medical care, included any newborn baby who died at home or where it took more than 12 hours to seek outside care; Delay 2, the transport delay, included newborn babies whose care givers expressed problems with getting transport; and Delay 3, the delay in receiving quality care, included delay in receiving or failure to receive quality care at a health facility (as judged by. .. births, gender, and residents of Volta and Northern geographical regions are positively and significantly associated with having babies with small sizes Overall, multiple births, gender and secondary education or better were consistently significant in predicting LBW and perceived baby size in both the logistic and ordered logistic regression models Maternal Socio-Economic Status and Childhood Birth... Ministry of health, Accra Ghana Statistical Service Ghana Statistical Service and Macro International Inc (MI) (2004) Ghana Demographic and Health Survey 2003 Calverton, Maryland: GSS and MI Ghana Statistical Service (GSS) and Macro International Inc (MI) (2009) Ghana Demographic and Health Survey 2008 Calverton, Maryland: GSS and MI Government of Ghana(GOG) The National Health Insurance Act: Act650 Accra:... Contribution of Low Birth Weight to Infant Mortality and Childhood Morbidity, New England Journal of Medicine 312: 82-90 Mbuya, M N N., Children, M., Chasekwa, B and Mishra, V (2010) Biological, Social and Environmental Determinants of Low Birth Weight and Stunting among Infants and Young Children in Zimbabwe, Zimbabwe Working Papers, No.7 Negi, K.S., Kandpal, S.D and Kukreti, M (2006), “Epidemiological Factors... Planning and Management, 2Department of Global Health, IHCAR, Division of Public Health, Karolinska Institutet 3Iganga/Mayuge Health and Demographic Surveillance Site 1,3Uganda 2Sweden 1 Introduction It has been proposed that the performance of a health system should be measured primarily by the effect on mortality Childbirth is the time of greatest risk of mortality for a mother and a baby [1] and thus care. .. immunization status, age, and education level) and the husband’s education level The results from Bategeka (2006) and Okurut (2009) reinforce the role of maternal socio-economic factors and biomedical inputs such as antenatal care services and tetanus vaccination on childhood birth weight The authors thus suggested that policy should be geared at, improving education of the girl child and improving access... shops and private clinics that are most often found in small trading centres, as well as in Iganga proper (Figure 5) All government and NGO facilities have clinical officers and nurses for health care delivery, apart from delivery provided by the hospital, which also has doctors Malaria is endemic, and pneumonia is prevalent in the district Fig 1 Map of Uganda showing the location of Iganga and Mayuge . NEONATAL CARE Edited by Deborah Raines and Zoe Iliodromiti Neonatal Care Edited by Deborah Raines and Zoe Iliodromiti. copies can be obtained from orders@intechopen.com Neonatal Care, Edited by Deborah Raines and Zoe Iliodromiti p. cm. ISBN 978-953-51-0692-0