The Effect Of Umbilical Cord Milking In Reducing ROP Of Preterm Babies.

Background: Recent advances in neonatal care in the last decade have improved the survival rates for premature infants. Consequently, the incidence of ROP has increased in parallel. ROP is under constant epidemiological study around the world. Prematurity, low birth weight, respiratory distress syndrome, mechanical ventilation, prolonged oxygen treatment and blood transfusion increase the risk of ROP. Umbilical cord milking reduces the incidence of ROP in preterm infants by reducing the need for blood transfusions in preterm infants. Objective: To observe effect of ROP with umbilical cord milking. Methodology: This prospective observational study was carried out on neonates, in the Department of Neonatology, BSMMU after approval from IRB. Neonates admitted into neonatal intensive care unit of BSMMU satisfying the inclusion and exclusion criteria was enrolled for the study. A written informed consent was taken from parents and assurance about confidentiality was given. Neonates born before 37 weeks of gestation was assigned to either umbilical cord milking or non-milking group at a 1: 1 ratio according to a computer generated randomized sequence. After delivery of a baby umbilical cord milking was performed by holding the infant at the level of the placenta. First eye evaluation for ROP was done at 20 days of age for gestational age less than 30weeks & weight below 1200gm & at 30 days of age for gestational age more than 30 weeks & above weight 1200gm. Follow-up was continued until retinal vascularization was completed. The follow-up schedules were organized depending on the retinal findings. The retinal finding was evaluated according to the International Classification of Retinopathy of Prematurity. The patients were grouped as no ROP, mild ROP (stages I-II ROP without plus disease, showed regression), and severe ROP (zone 1 or zone 2, stage III, aggressive ROP without stages, stage II with plus disease who required treatment). Data were recorded in a preformed questionnaire and data were analyzed by statistical package for social sciences (SPSS) version 20. Results: 114 newborns were enrolled in this study. Then among 114 preterm neonates 57 were randomized to umbilical cord milking group and 57 were randomized to no milking group. Baseline characteristics were almost similar between the two groups. There were significant increase is hematocrit level 57.3 ±3.5 V 47.4 ± 4.5 (P value less than 0.001), reduction in need of blood transfusion 3.5% V 42.1% (P value less than 0.001) & reduction in ROP 3.5% V 19.3% (P 0.007). Conclusion: This study concluded that umbilical cord milking after delivery improves hematocrit level, reduces need of blood transfusion & reduces the incidence of ROP in preterm infant

Efficacy of expressed breast milk alone or in combination with paracetamol in reducing pain during retinopathy of prematurity screening: A randomized controlled trial

Background: The aim of this study was to determine the efficacy of expressed breast milk (EBM) alone or in combination with oral paracetamol for pain reduction during retinopathy of prematurity (ROP) screening.  Methods: A randomized control trial was conducted in two departments of Bangabandhu Sheikh Mujib Medical University. A total of 60 preterm neonates who underwent ROP screening were randomized into three equal groups. Group A got nesting and swaddling as per institutional protocol (control). Group B received 2 ml EBM two minutes prior to the ROP screening and Group C received 15 mg/kg syrup paracetamol 30 minutes prior to the ROP screening and EBM like Group B. Premature infant pain profile (PIPP) scores was used prior, during and 2 minutes after ROP screening procedure. Results: The three groups were similar in terms of baseline characteristics. The mean (standard deviation) PIPP scores during the procedure were 16.4 (1.1), 15.0 (1.8) and 13.4 (1.8) in control, EBM, and EBM with paracetamol groups respectively. The PIPP scores were significantly lower in the EBM and EBM with paracetamol groups during the procedure compared to control group. In the EBM and EBM with paracetamol groups, the mean difference in PIPP scores (between before and during the procedure) was also substantially lower. Conclusion: Breast milk alone or in combination with paracetamol can reduce significant pain during ROP screening than control group. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(2): 106-11

Vaccination following the expanded programme on immunization schedule could help to reduce deaths in children under five hospitalized for pneumonia and severe pneumonia in a developing country

BackgroundWorldwide, pneumonia is the leading cause of mortality in children under the age of five. An expanded program on immunization (EPI) is one kind of evidence-based tool for controlling and even eradicating infectious diseases.ObjectivesThis study aimed to explore the impact of EPI vaccination, including BCG, DPT-Hib-Hep B, OPV, IPV, and PCV-10, among children from the age of 4 to 59 months hospitalized for pneumonia and severe pneumonia. Additionally, we evaluated the role of 10 valent pneumococcal conjugate vaccines alone on clinical outcomes in such children.MethodsIn this retrospective chart review, children from the age of 4 to 59 months with WHO-defined pneumonia and severe pneumonia admitted to the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) between August 2013 and December 2017 who had the information on immunization as per EPI schedule by 4 months of age were included in the analysis. A comparison was made between the children who were fully immunized (immunization with BCG, DPT-Hib-Hep B, OPV, and IPV from 2013 to 2015 and PCV-10 from 2015 to 2017) and who were not immunized (consisting of partial immunization and no immunization) during the study period.ResultsA total of 4,625 children had pneumonia and severe pneumonia during the study period. Among them, 2,605 (56.3%) had received the information on immunization; 2,195 (84.3%) were fully immunized by 4 months of age according to the EPI schedule and 410 were not immunized. In the log-linear binomial regression analysis, immunization of children from 4 to 59 months of age was found to be associated with a lower risk of diarrhea (p = 0.033), severe pneumonia (p = 0.001), anemia (p = 0.026), and deaths (p = 0.035). Importantly, the risk of developing severe pneumonia (1054/1,570 [67%] vs. 202/257 [79%], p < 0.001) and case-fatality rate (57/1,570 [3.6%] vs. 19/257 [7.4%], p = 0.005) was still significantly lower among those who were immunized with PCV-10 than those who were not.ConclusionChildren immunized as per the EPI schedule were at a lower risk of diarrhea, severe pneumonia, anemia, and death, compared to unvaccinated children. In addition, PCV-10 was found to be protective against severe pneumonia and deaths in vaccinated children. The overall results underscored the importance of the continuation of immunization, scrupulously adhering to the EPI schedule to reduce the risk of morbidities and mortalities in children, especially in resource-limited settings

Causes of neonatal and maternal deaths in Dhaka slums: Implications for service delivery

BACKGROUND: Bangladesh has about 5.7 million people living in urban slums that are characterized by adverse living conditions, poor access to healthcare services and health outcomes. In an attempt to ensure safe maternal, neonatal and child health services in the slums BRAC started a programme, MANOSHI, in 2007. This paper reports the causes of maternal and neonatal deaths in slums and discusses the implications of those deaths for Maternal Neonatal and Child Health service delivery. METHODS: Slums in three areas of Dhaka city were selected purposively. Data on causes of deaths were collected during 2008-2009 using verbal autopsy form. Two trained physicians independently assigned the cause of deaths. RESULTS: A total of 260 newborn and 38 maternal deaths were identified between 2008 and 2009. The majority (75%) of neonatal deaths occurred during 0-7 days. The main causes of deaths were birth asphyxia (42%), sepsis (20%) and birth trauma (7%). Post partum hemorrhage (37%) and eclampsia (16%) were the major direct causes and hepatic failure due to viral hepatitis was the most prevalent indirect cause (11%) of maternal deaths. CONCLUSION: Delivery at a health facility with child assessment within a day of delivery and appropriate treatment could reduce neonatal deaths. Maternal mortality is unlikely to reduce without delivering at facilities with basic Emergency Obstetric Care (EOC) and arrangements for timely referral to EOC. There is a need for a comprehensive package of services that includes control of infectious diseases during pregnancy, EOC and adequate after delivery care

Lectin Coated Electrodes For Biosensor Water Testing Applications

Waterborne diseases account for millions of deaths each year. Developing countries struggle with infectious outbreaks occurring due to the presence of microbial agents in the water supply, and the morbidity rate remains high due to lack of detection. Even in the United States with modern water treatment facilities, lost productivity due to waterborne pathogens costs an estimated $20 million per year. There are many contaminants that are difficult and costly to detect even in developed countries, such as cyanobacteria. Cyanobacteria has particularly been a problem in upstate South Carolina, and the presence of this contaminant affects the quality of water and can make people ill at high levels. Thus, there is a need for simple and affordable tests to detect a wide variety of microorganisms. Our novel biosensor utilizes plant-based, sugar-binding lectin arrays to bind microorganisms on electrode surfaces. Our group has found during testing that pathogens bind strongly and selectively to certain lectin-coated electrodes, which impedes the flow of electricity between two electrodes, increasing resistance. Quantification of this change in resistance can be used to determine the presence of different types of bacteria. Several different design iterations of this lectin-based biosensor were evaluated with three different types of bacteria: Escherichia coli, Staphylococcus aureus, and Anabaena flos-aquae, a type of filamentous cyanobacteria. Different lectins, including concanavalin A, peanut agglutinin, and wheat germ agglutinin, were evaluated for cyanobacteria binding. It was found that resistance-based measurements were not adequately stable for field testing; thus, a sensor based on refractive index with lectin coated optical fibers was tested with more promising results for the detection cyanobacteria

Lectin Coated Electrodes For Biosensor Water Testing Applications

Waterborne diseases account for millions of deaths each year. Developing countries struggle with infectious outbreaks occurring due to the presence of microbial agents in the water supply, and the morbidity rate remains high due to lack of detection. Even in the United States with modern water treatment facilities, lost productivity due to waterborne pathogens costs an estimated $20 million per year. There are many contaminants that are difficult and costly to detect even in developed countries, such as cyanobacteria. Cyanobacteria has particularly been a problem in upstate South Carolina, and the presence of this contaminant affects the quality of water and can make people ill at high levels. Thus, there is a need for simple and affordable tests to detect a wide variety of microorganisms. Our novel biosensor utilizes plant-based, sugar-binding lectin arrays to bind microorganisms on electrode surfaces. Our group has found during testing that pathogens bind strongly and selectively to certain lectin-coated electrodes, which impedes the flow of electricity between two electrodes, increasing resistance. Quantification of this change in resistance can be used to determine the presence of different types of bacteria. Several different design iterations of this lectin-based biosensor were evaluated with three different types of bacteria: Escherichia coli, Staphylococcus aureus, and Anabaena flos-aquae, a type of filamentous cyanobacteria. Different lectins, including concanavalin A, peanut agglutinin, and wheat germ agglutinin, were evaluated for cyanobacteria binding. It was found that resistance-based measurements were not adequately stable for field testing; thus, a sensor based on refractive index with lectin coated optical fibers was tested with more promising results for the detection cyanobacteria

Satisfaction Level of Slum Dwellers with the Assistance of the City Corporation during COVID-19: The Bangladesh Context

The COVID-19 pandemic has affected Bangladesh’s economic and social well-being in many ways. Slum dwellers, including day laborers, rickshaw pullers, CNG (Compressed Natural Gas) drivers, housemaids, hawkers, and street vendors, were the worst victims of this pandemic. Besides the voluntary organizations, the City Corporation (urban local government), instructed by the central government, took the initiative to distribute necessary food as well as financial assistance to the city dwellers to survive during the lockdown. The objective of this study is to identify the satisfaction level of slum dwellers with the assistance received from the City Corporation and obtain an idea of whether these supports were enough for them to maintain their livelihood. This is a mixed method research consisting of both qualitative and quantitative approaches. Researchers conducted a field survey in Sylhet City Corporation, in the northeastern part of Bangladesh, and collected primary data from one hundred and fifty-five respondents through a structured questionnaire along with an interview (semi-structured) schedule. Samples were selected by applying a multistage sampling technique. Researchers analyzed quantitative data using SPSS software and qualitative data using the thematic analysis method. Study findings reveal that nepotism, patron–client relation, corruption, unequal treatment, management flaws, low level of community engagement, political consideration, and lack of monitoring were the major issues in providing effective service delivery to slum dwellers during COVID-19. Citizen participation, well coordination, proper monitoring, impersonality, and good governance are indispensable for dealing with any crisis