Premature and Low Birth Weight (NICU)at Pediatric Department Premature and Low Birth Weight (NICU)at...
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Premature and Low Birth Weight (NICU)at Pediatric Department (Kampong-Cham Provincial Hospital) LORN TRY Patrick,MD,DES,AFSA,DCH,DHM Assist.Professor of Pediatric,IU,SHU Chief of Pediatric Department,Deputy director Kampong.Cham Provincial Hospital
Transcript of Premature and Low Birth Weight (NICU)at Pediatric Department Premature and Low Birth Weight (NICU)at...
Premature and Low Birth Weight(NICU)at Pediatric Department
(Kampong-Cham Provincial Hospital)
LORN TRY Patrick,MD,DES,AFSA,DCH,DHMAssist.Professor of Pediatric,IU,SHUChief of Pediatric Department,Deputy directorKampong.Cham Provincial Hospital
Layout of the presentation
• Epidemiology
– Under-5 mortality in Cambodia
– Date on prematures/LBW in neonate unit, Kampong Provincial Referral Hospital (PRH)
• Criteria for admission of neoanates
• Referral form for neonates
• Management of premature/LBW
– Score de FARR
Layout of the presentation
• Management of premature/LBW
– Classification of newborns by intrauterine growth & gestational age
– Score de Silverman (respiratory distress)
– Management of premature/LBW
– Use of steroids and its outcomes
• Challenges, lessons learnt and ways forward
Under-5 mortality in Cambodia
• Cambodia continues to suffer from very high neonatal mortalities:
– 28/1000 live births (CDHS2005);
– 27/1000 live births (CDHS2010),
– 18.4/1000 lives birth (Report 2013, New York, UNICEF,2013) WHO Western Pacific Region
.
Problem and problem analysis, Kampong Cham PRH, 2009-2014
39%42%
48%53% 52%
56%
28%24% 23%
19% 21% 19%
33% 34%29% 28% 26% 25%
0%
10%
20%
30%
40%
50%
60%
2009 2010 2011 2012 2013 2014
Pe
rce
nta
ge
Years
Premature birth asphyxia infection
Causes of neonate deaths, Kampong Cham PRH, 2013 (N=111),2014
80
20
92
102
19 16
1
Premature Birth asphyxia Infection Neo tetnus
0
20
40
60
80
100
120
Causes of deaths
Nu
mb
er
of
de
ath
s
2013 2014
Number of Neonates admitted to the Neonate Unit and Its CFR (%) (N=1009), 2011-2012 (17 months)
9
103
556
333
8
89%
42%
10% 7%0% 0%
20%
40%
60%
80%
100%
0
100
200
300
400
500
600
< 1 1-1.5 1.6-2.5 2.6-3.9 >4
CFR
(%
)
Nu
mb
er
of
Ne
on
ate
s
Weights of Neonates (Kg)
Number of Neonates CFR
Number of Neonates admitted to the Neonate Unit and Its CFR (%) (N=1038), 2014 (12 Months)
11
150
515
350
13
100%
39%
8% 8%0% 0%
20%
40%
60%
80%
100%
120%
0
100
200
300
400
500
600
< 1 1-1.5 1.6-2.5 2.6-3.9 >4
CFR
(%
)
Nu
mb
er
of
Ne
on
ate
s
Weights of Neonates (Kg)
Number of Neonates CFR
ADMISSION CRITERIA
• Low birth weigh < 2000 g
• Birth asphyxia ( Apgar score 3 at 0 mn or < 7 at 5 mn)
• Fever of mother T0 ≥ 380 c (before or at delivery)
• Premature rupture of membrane > 18 hours
• Premature rupture of membrane > 12 hours + bad coloration (green) or bad smelling of amniotic fluid.
Prepare by Dr.LORN TRY Patrich,Pediatrician,Deputy director of
hospital10/23/2011 9
ADMISSION CRITERIA (con’t)
• Other signs of baby :
– Respiratory Distress syndrome
– Central or peripheral cyanosis
– Jaundice in 24 hours of life
– Convulsion
– Vomiting
– Fever > 38o c
– Bleeding
– No succion , No cry
Prepare by Dr.LORN TRY Patrich,Pediatrician,Deputy director of
hospital10/23/2011 10
11
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Management
Management of Premature/LBW in Kampong Cham PRH
• Put in incubator
• Blood glucose
• Fluid IV (D 10%) 3 days after that change
• AB by National Guideline Neonatal sepsis
• Nutrition Enteral (by nasogastric tube) if weight <1500g (Breast milk)
Management of Premature/LBW in Kampong Cham PRH (con’t)
• Vit K
• CPAP or intubation if RDS
• Discharge with KMC at home
• Follow up in 2 Months (Exam Ophtalmology, Psycomotor developpement , Iron supplementary)
Correlation between use of steroids and CFR, Kampong Cham PRH, 2012, 2014
18
14
0
2
4
6
8
10
12
14
16
18
20
0 10 20 30 40 50 60 70
CFR
(%
)
Use of steroid (%)
Challenges
• Intensive work with close monitoring
• Shortage of staff
• Lack of materials and maintenance not in place
• No transport system of babies to NICU
• Space is not permitted to implement KMC
• No feedback information for the babies who are referred to other health facilities
• Limited space of the NICU and increased number of admission
Prepare by Dr.LORN TRY Patrich,Pediatrician,Deputy director of
hospital10/23/2011 20
Lessons learnt• Annually increased number of sick newborns
admitted to NICU
• Improved care, especially mothers with complications and other underlying diseases (HBP, eclampsia, and urinary tract infections , diabetes, chorioamniolitis, …. )
• Improved practices of sick children
– Emergency care of sick newborn
– KMC
– Breastfeeding
– Transfer of babies which requires further assistance from maternity ward
Lessons learnt (con’t)
• Improved post natal care (PNC)
– Early detection and referral of sick newborns
– Exclusive breastfeeding
– Hygienic cord/skin care
– Recognition of danger signs and knowing when to seek care
– Where referral is not possible, neonatal sepsis should be considered
• Stronger commitment of supports from management levels (MoH, PHDO, Hospital) and development partners
Ways forwardAdvocate for supporting the following:
• Increase number of staff and train them in neonatal care (MOH/PHDO/Hospital?)
• Expand the INCU and space for KMC (MoH/PHDO/Hospital/Partners?)
• Identify budget for purchasing and maintaining the equipments and for ensuring supplies (MoH/PHDO/Partners?)
• Identify appropriate referral system in the hospital from maternity ward to INCU
References
1. Action plan for healthy newborn infants in the Western Pacific region (2014-2020),WHO Regional office for the Western Pacific, ISBN 978 92 90616634,2014.
2. Safe Motherhood Clinical management Protocols referral hospital,National reproductive Health Program, Ministry of Health, June 2013 .
3. CPG Neonatal sepsis,Working group,MOH 2012
THANK YOU VERY MUCH
