Journal Issue: Volume: 45, No. 2 (2025): May - Aug
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2025
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ISSN 1990-7974 eISSN 1990-7982
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Articles
A Comparative Cross-sectional Study on Determinants of Birth Asphyxia in Referral and District Hospital Settings
(Perinatal Society of Nepal (PESON), 2025) Koirala, Jaya; Kharde, Sangeeta; Poudel, Pradish; Takahashi, Kumi; Dahal, Pratikshya Sharma; Jamir, Arenlila
Abstract:
Introduction : Birth asphyxia is a leading cause of neonatal morbidity and mortality in India. This study aimed to identify determinants of birth asphyxia among mothers delivering at a referral centre and a district hospital in the northern region of southern India.
Methods : A cross-sectional comparative study was conducted from January to June 2023 involving 334 mothers (167 from each facility) selected through purposive sampling. Data were analyzed using Excel and SPSS. Descriptive and inferential statistics, including binary logistic regression, were applied to identify factors associated with birth asphyxia.
Results : The mean maternal age was 23.83 ± 3.75 years. Maternal anemia, alcohol consumption, primiparity, and low family income were significantly associated with birth asphyxia across both settings. Moderate anemia notably increased risk at the referral centre (OR = 45.02, p = 0.01), while mild anemia was a significant risk factor at the district hospital (OR = 18.62, p = 0.002). Alcohol use markedly elevated birth asphyxia risk; conversely, abstinence was protective (referral centre OR = 0.03, p = 0.028; district hospital OR = 0.01, p = 0.013). Dietary pattern was a significant factor only at the district hospital, with pure vegetarian mothers showing higher risk (OR = 15.89, p = 0.025). Maternal age, residence, antenatal visits, and smoking showed no significant associations.
Conclusion : Maternal anemia, alcohol consumption, primiparity, low socioeconomic status, and specific dietary patterns are key determinants of birth asphyxia. Targeted interventions to improve maternal nutrition and reduce substance use are essential to lowering birth asphyxia incidence and improving neonatal outcomes.
A Cross-Sectional Study on Comparison of Health-Seeking Behaviour Among Well-Nourished and Malnourished Children in Vadodara Rural India
(Perinatal Society of Nepal (PESON), 2025) Sheth, Margi; Damor, Raman; Vala, Astha; Shringarpure, Kalpita; Patel, Nirav
Abstract:
Introduction: Mothers play a crucial role in identifying health changes in their children, influencing health-seeking behaviours in acute illness and treatment seeking behaviour during growth faltering. Insights of the health-seeking behaviour in local context gives the better result in improving the nutritional status at hospital as well as community level. Therefore, this study was conducted to compare health-seeking behaviors among mothers of well-nourished and malnourished children and to explore treatment-seeking pathways for malnourished children.
Methods: A community-based cross-sectional study was conducted among mothers of children aged 6 to 60 months attending anganwadis in Vadodara Rural Taluka. A total of 120 well-nourished and 126 malnourished children (63 with Severe Acute Malnutrition [SAM] and 63 with Moderate Acute Malnutrition [MAM]) were included using a thirty-cluster sampling technique. Mothers were interviewed regarding health-seeking behaviours over the past six months, and pathways to Nutritional Rehabilitation Centre (NRC)/Community Malnutrition Treatment Centre for SAM treatment were assessed.
Results: Among well-nourished children, 36% experienced illness, with a median duration of six days; 96% consulted healthcare workers with a median delay of three days. For malnourished children, 53% reported illness, and only 53% sought care, facing a median delay of seven days. Of the 63 SAM children referred to NRC/CMTC, only 22% visited. Major barriers to attendance included the lack of someone to care for other children and no accompanying adult for hospital visits.
Conclusions: Mother of well-nourished children demonstrated prompt health-seeking behaviours, while malnourished children faced significant delays and barriers. Nearly half of the referred SAM children to NRC/CMTC did not visit the place, major reason was longer duration of hospital stay.
Clinical Spectrum of Malaria in Hospitalised Children at a Tertiary care Centre in North India - A Retrospective study
(Perinatal Society of Nepal (PESON), 2025) Pandey, Charu; Singh, Rajesh Kumar
Abstract:
Introduction : Malaria continues to cause high morbidity and mortality in the tropical countries, children being among the vulnerable age group. We conducted a retrospective study at a tertiary care centre in northern India to determine the pattern of the disease in our area.
Methods: A descriptive retrospective in children aged 1 month to 18 years of age, admitted at our paediatric unit, with positive antigen test and/or peripheral smear for malaria. Presenting features, clinical signs, laboratory parameters, treatment and outcome were recorded. Statistical analysis was done using freely available software online.
Results: 57 patients tested positive for malaria. The parasite species found in all positive tests was Plasmodium vivax. 22 (38.5%) of patients were classified as severe malaria. M:F ratio of 1.03:1. Fever was the most common presenting complain (100%), followed by pallor (52.6%) and persistent vomiting (35%). Antimalarial given was injection Artesunate in 53 (93%) of patients, oral artemeter lumefantrine was started as primary treatment in 3 (5.26%) patients, while chloroquine was given to only 1 (1.7%) patient. Blood component transfusion was required in 11 patients. 54 (94.7%) patients improved and were discharged, while 1(1.7%) patient was referred to higher centre, 2 (3.5%) patients left against medical advice. Mean duration of hospital stay was 6.2 (±2.35) days.
Conclusions: Plasmodium vivax was the leading cause of malaria at our institute, causing both severe and uncomplicated malaria. Plasmodium vivax is no longer a benign entity.
Neurodevelopmental Outcome Following Therapeutic Hypothermia for Perinatal Asphyxia: A Cohort Study
(Perinatal Society of Nepal (PESON), 2025) Dongol, Srijana; Poudyal, Prithuja; Thapa, Sameera
Abstract:
Introduction: Therapeutic hypothermia is recommended for the treatment of neonates with hypoxic-ischemic encephalopathy (HIE). We conducted a cohort study to assess the neuroprotective benefits of therapeutic hypothermia by analyzing the survival and neurodevelopmental outcomes of neonates with moderate to severe HIE who underwent therapeutic hypothermia compared to those who did not.
Methods: Neonates with gestational age >36 weeks and age <6 hours with moderate to severe HIE were included in the study. Those who underwent therapeutic hypothermia according to a predefined criteria were assigned to the hypothermia group, while those who did not receive hypothermia served as the control group. Neurodevelopmental outcomes were assessed using the Ages & Stages Questionnaires (ASQ-3) at 3, 6, and 12 months of age.
Results: A total of 208 asphyxiated newborns were included in the study, with 100 in the therapeutic hypothermia group and 100 in the control group. Mortality was higher in the control group compared to the hypothermia group. Neurodevelopmental outcomes at 3, 6, and 12 months were significantly better in the hypothermia group compared to the control group.
Conclusion: Our study suggests that therapeutic hypothermia in term newborns with moderate to severe HIE is associated with improved survival and reduced neurologic sequelae. These findings support the implementation of therapeutic hypothermia as a standard treatment for neonates with perinatal asphyxia.
Predictive Value of Umbilical cord Blood Albumin in early Identification of Neonatal Hyperbilirubinemia: An Observational Study
(Perinatal Society of Nepal (PESON), 2025) Singh, Priyamvada; Balhara, Kirtika; Antil, Parveen; Kapoor, Satya Kiran
Abstract:
Introduction: Neonatal hyperbilirubinemia (NH) clinically presents as yellowish discoloration of the skin and sclera. The anticipation of jaundice through the evaluation of cord albumin aims to identify infants at risk of neonatal hyperbilirubinemia promptly, allowing for early intervention to mitigate the potential for bilirubin-induced brain damage.
Methodology: A total of 266 eligible neonates were enrolled in the study.Cord albumin samples of neonates were categorized into three distinct study groups based on cord blood albumin levels: group A (CBA <2.8g/dl), group B (CBA-2.8-3.3g/dl) and group C (CBA >3.3g/dl).All neonates (except excluded babies) were followed starting at 24 hours till 72 hours. If Kramer's score exceeded zone 2 on day 1 or zone 3 on day 2/day3 of birth then 1ml of peripheral venous blood was collected and sent for serum bilirubin estimation.
Results: On day 2, 30 neonates out of 31 in group A, 25 out of 28 in group B and 3 out of 141 in group C needed phototherapy. On day 3, 8 neonates out of 31 in group A, 1 out of 28 in group B and none of the babies in group C needed phototherapy.In group A, 1 out of 31 neonates needed double volume exchange transfusion on day 3 of life and none of the neonates in group B and C needed exchange transfusion.
Conclusion: This study demonstrates cord blood albumin levels as a prognostic indicator for estimation of serum bilirubin which allows a more tailored approach to neonatal care.