Clinical and antenatal profile in late pre term and term neonate A cross sectional study

Parents or guardians of all the neonates shall be invited to participate in study. who will give consent to participate in study shall be enrolled in the study.

Detailed Methodology

The Date of the Last Menstrual Cycle and early obstetric Ultrasonography Scan 6-12 weeks will be used to estimate gestation if available.

The Expanded New Ballard score will be used for infants delivered on uncertain dates or in which LMP or USG not available. From the time of delivery until discharged, the newborns will be subjected to daily clinical examinations. All the newborns in the study will be treated according to their clinical status on case to case basis by respective units.

In a structured Proforma all clinically relevant data will be recorded.

Till Discharge all newborns included in the study will be assessed daily for any morbidity, and data will be entered into clinical records.

 Parameters recorded for the study

1     Information of Mother: which will include Pre-natal and Natal History.

 Pre-Natal History will include- Mothers Age, family background, singleton or multiple births, pre-natal information like- PROM, Polyhydramnios, hypertension, gestational diabetes mellitus, maternal infection etc.

 Natal History will include time of true labour pains, duration of rupture of membrane, indication of pre-term delivery, delivery mode- Normal Vaginal Delivery or Lower Segment Cesarian Section (LSCS)

 2     Neonatal Parameter will include- Weight for gestation, gender, weight at birth, APGAR score at 1min, 5min

In case of NICU admission, details will be taken such as cause of NICU admission Respiratory difficulties and Requirement of Ventilation, Nenonatal Hyperbilurubinemia, Hypothermia, Hypoglycemia, Sepsis, Requirement of IV medications, feeding problems

Any re-admission within one week after discharge and cause for readmission after discharge will be recorded.

 Discharge or Mortality will be recorded.

 Definitions

Hypoglycemia- It is defined as a blood glucose value of less than 40 mg/dL plasma glucose less than 45 mg/dL

Hypothermia- Body Temperature Less than 36.5 C

Cold stress or mild hypothermia 36.0 to 36.4 C

Moderate hypothermia: 32 to 35.9°C

Severe hypothermia: <32°C.

 Feeding ProblemsInadequate feeding

 Hyperbilirubinemia- Total Serum Bilirubin TSB levels have been arbitrarily defined as, Pathological, if it exceeds 5 mg/ dL on first day, 10 mg/ dL, on second day, or 15 mg/ dL thereafter in term babies.

Presence of any of the following signs indicates

pathological jaundice:

Clinical jaundice detected before 24 hours of age

Rise in serum bilirubin by more than 5 mg/ dL/ day

Serum bilirubin more than 15 mg/dL

Clinical jaundice persisting beyond 14 days of life

Clay-/white-colored stool and/or dark urine staining

the clothes yellow

Direct bilirubin >2 mg/ dL at any time.

 Neonatal Sepsis- It is a clinical syndrome characterised by infection-related signs and symptoms in the first month of life, either with or without bacteremia. It includes different infant systemic illnesses like septicemia, meningitis, pneumonia, arthritis, osteomyelitis, and UTI.

Perinatal Asphyxia- World Health Organisation WHO Failure to initiate and Sustain breathing .

National Neonatal Perinatal Database Moderate Perinatal Asphyxia- Slow/Gasping Breathing   or an APGAR score of 4-6 at 1 minute

Severe Perinatal Asphyxia- No breathing or an APGAR score of 0-3 at 1 minute of birth.

  Details which will be recorded at time of discharge- Weight of baby, length, Head Circumference, Duration spent in hospital, final Diagnosis.

 Babies will be followed up in OPD for routine checkup and evaluation till neonatal period first 28 days of life

 Families will be contacted via Phone to Enquire about the health status, including Compulsory OPD visit on Day 7 and Day 28 of life.