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Background In low-income settings, community health workers (CHWs) are frequently the first point of contact for newborns. Mobile technology may aid health workers in classifying illness and providing referral and management guidance for newborn care. This study evaluates the potential for mobile health technology to improve diagnosis and case management of newborns in Bangladesh. Methods A mobile application based on Bangladesh’s Comprehensive Newborn Care Package national guidelines (mCNCP) was developed to aid CHWs in identifying and managing small and sick infants. After a 2-day training, CHWs assessed newborns at Sylhet Osmani Medical College Hospital and in the Projahnmo research site (Sylhet, Bangladesh) using either mCNCP or a comparable paper form (pCNCP), similar to standard IMCI-formatted paper forms. CHWs were randomized to conduct a block of ~ 6 newborn assessments starting with either mCNCP or pCNCP, then switched to the alternate method. Physicians using mCNCP served as gold standard assessors. CHW performance with mCNCP and pCNCP were compared using chi-squared tests of independence for equality of proportions, and logistic regressions clustered by CHW. Results Two hundred seven total CHW assessments were completed on 101 enrolled infants. mCNCP assessments were more often fully completed and completed faster than pCNCP assessments (100% vs 23.8%, p  < 0.001; 17.5 vs 23.6 min; p  < 0.001). mCNCP facilitated calculations of respiratory rate, temperature, and gestational age. CHWs using mCNCP were more likely to identify small newborns (Odds Ratio (OR): 20.8, Confidence Interval (CI): (7.1, 60.8), p  < 0.001), and to correctly classify 7 out of 16 newborn conditions evaluated, including severe weight loss (OR: 13.1, CI: (4.6, 37.5), p  < 0.001), poor movement (OR: 6.6, CI: (2.3, 19.3), p  = 0.001), hypothermia (OR: 14.9, CI: (2.7, 82.2), p  = 0.002), and feeding intolerance (OR: 2.1, CI: (1.3, 3.3), p  = 0.003). CHWs with mCNCP were more likely to provide counseling as needed on 4 out of 7 case management recommendations evaluated, including kangaroo mother care. Conclusions CHWs in rural Bangladesh with limited experience using tablets successfully used a mobile application for neonatal assessment after a two-day training. mCNCP may aid frontline health workers in Bangladesh to improve completion of neonatal assessment, classification of illnesses, and adherence to neonatal management guidelines.

Background The assessment of the newborn after birth is fundamental for identifying those requiring resuscitation. Certain components of the Apgar score are used to assess neonatal condition, but their value is insufficiently validated. We aimed to identify the components of the Apgar score that predict neonatal resuscitation. Methods Individual patient data from two multicenter trials were analyzed. Preterm newborns under 32 weeks of gestation and term newborns with perinatal acidosis and/or resuscitation were included. The extent of resuscitation was quantified by a standardized scoring system, and the clinical condition was quantified by a specified Apgar score. Correlation, linear regression and ROC analyses were used to address the study question. Results A total of 2093 newborns were included. Newborns in poor clinical condition at 1 min received more interventions at 5 and 10 min. Heart rate, muscle tone, reflexes and breathing quality, but not skin color, were moderately strong correlated with the extent of resuscitation at 5 ( r  = 0.44 to 0.52) and 10 min ( r  = 0.38 to 0.42). Heart rate, reflexes and chest movement at 1 min best predicted the subsequent need for resuscitation (R 2  = 0.31). The rare interventions of intubation, chest compressions and epinephrine administration can be predicted by the newborn’s condition at one minute, with a high sensitivity of 84% (cutoff ≤ 4 Apgar points) or a high specificity of 86% (cutoff ≤ 7 Apgar points). Conclusions The clinical impression at 1 min can help to predict the need for medical interventions. Contrary to recent guidelines, heart rate, reflexes and chest movement seem to have the highest values. Trial registration The Test APGAR study was registered at clinicaltrials.gov (NCT00623038, 14/08/2008).

Background Mature oral feeding is a complex function involving numerous muscles and nerves, typically developing between the postmenstrual age of 34–36 weeks in newborn infants. The objective of this study was to analyze the oral feeding skills of healthy late preterm, early term, and full-term infants using a neonatal oral feeding monitor. Methods We used the oral feeding parameters reported by NeoSAFE which is a certified medical device, to assess the swallowing and swallow-respiration coordination in newborn infants. Oral feeding parameters were recorded over a 2-minutes long bottle-feeding session. The total swallow count, swallow time, maximum rhythmic swallows, resting interval duration, time between rhythmic swallows and inspiration after swallow count were recorded by NeoSAFE. We planned to examine the relationship of oral feeding parameters according to the gestational age. We also investigated whether the coordination of swallowing and respiration changes with respect to gestational age in newborn infants. Results A total of 88 infants were included; 34 late preterm, 34 early term, and 20 full term. The gestational age was found to have significant negative correlation with the average time between rhythmic swallows and positive correlation with the swallow time. Feeding volume was found to have a negative correlation with the resting interval duration and average time between rhythmic swallows. It was also found that the feeding volume has a positive correlation with total swallow count, swallow time, maximum rhythmic swallow and inspirium after swallow count. Conclusion Although the oral feeding skills of infants at 34 weeks gestation are still developing, this study identified differences in oral feeding skills among late preterm, early term, and full-term infants when assessed using a neonatal swallow and respiration detection system. However, conducting larger cohort studies using NeoSAFE would be beneficial for guiding oral feeding approaches in infants. Trial Registration Not applicable.

Background Poor intrapartum care in India contributes to high maternal and newborn mortality. India’s Labor Room Quality Improvement Initiative (LaQshya) launched in 2017, aims to improve intrapartum care by minimizing complications, enforcing protocols, and promoting respectful maternity care (RMC). However, limited studies pose a challenge to fully examine its potential to assess quality of maternal and newborn care. This study aims to bridge this knowledge gap and reviews LaQshya’s ability to assess maternal and newborn care quality. Findings will guide modifications for enhancing LaQshya’s effectiveness. Methods We reviewed LaQshya’s ability to assess the quality of care through a two-step approach: a comprehensive descriptive analysis using document reviews to highlight program attributes, enablers, and challenges affecting LaQshya’s quality assessment capability, and a comparison of its measurement parameters with the 352 quality measures outlined in the WHO Standards for Maternal and Newborn Care. Comparing LaQshya with WHO standards offers insights into how its measurement criteria align with global standards for assessing maternity and newborn care quality. Results LaQshya utilizes several proven catalysts to enhance and measure quality- institutional structures, empirical measures, external validation, certification, and performance incentives for high-quality care. The program also embodies contemporary methods like quality circles, rapid improvement cycles, ongoing facility training, and plan-do-check, and act (PDCA) strategies for sustained quality enhancement. Key drivers of LaQshya’s assessment are- leadership, staff mentoring, digital infrastructure and stakeholder engagement from certified facilities. However, governance issues, understaffing, unclear directives, competency gaps, staff reluctance towards new quality improvement approaches inhibit the program, and its capacity to enhance quality of care. LaQshya addresses 76% of WHO’s 352 quality measures for maternal and newborn care but lacks comprehensive assessment of crucial elements: harmful labor practices, mistreatment of mothers or newborns, childbirth support, and effective clinical leadership and supervision. Conclusion LaQshya is a powerful model for evaluating quality of care, surpassing other global assessment tools. To achieve its maximum potential, we suggest strengthening district governance structures and offering tailored training programs for RMC and other new quality processes. Furthermore, expanding its quality measurement metrics to effectively assess provider accountability, patient outcomes, rights, staff supervision, and health facility leadership will increase its ability to assess quality improvements.

The experience of midwifery students in receiving the newborn at birth, before and after structured training in neonatal resuscitation: A pilot study. The practice of receiving the newborn, including neonatal resuscitation is an essential component of midwifery. Anecdotal evidence suggests preparation for the task is ad hoc within midwifery curricula, leading to student's anxiety. This paper reports impacts of neonatal resuscitation training upon levels of knowledge, preparedness, and anxiety for midwifery students receiving the newborn. Midwifery students participated in an online questionnaire before and after neonatal resuscitation training. The responses collected were subjected to descriptive analysis. Of 10 students invited, 6 completed the pre and post course questionnaires. Knowledge of the responsibility in receiving the newborn and instigation of resuscitation increased after attending the course. Steps to prepare to receive the newborn and clinical signs for initial assessment remained static. Students felt more prepared to receive the newborn after the course but did not improve in their preparation to initiate resuscitation. Anxiety levels remained static. Structured neonatal resuscitation training and strategies to ensure application of skills learnt should be embedded into midwifery curricula. Midwifery students' experience in receiving the newborn and neonatal resuscitation is worthy of further study.

The Pregnancy and Newborn Diagnostic Assessment (PANDA) system is a digital clinical decision support tool that can facilitate diagnosis and decision-making by health care personnel in antenatal care (ANC). Studies conducted in Madagascar and Burkina Faso showed that PANDA is a feasible system acceptable to various stakeholders. This study primarily aims to evaluate the effects of the PANDA system on ANC quality at rural health facilities in Burkina Faso. The secondary objectives of this study are to test the effects of the PANDA system on women's satisfaction, women's knowledge on birth preparedness and complication readiness, maternal and child health service use, men's involvement in maternal health service utilization, and women's contraception use at 6 weeks postpartum. Further, we will identify the factors that hinder or promote such an app and contribute to cost-effectiveness analysis. This is a randomized controlled trial implementing the PANDA system in 2 groups of health facilities (intervention and comparison groups) randomized using a matched-pair method. We included pregnant women who were <20 weeks pregnant during their first antenatal consultation in health facilities, and we followed up with them until their sixth week postpartum. Thirteen health centers were included, and 423 and 272 women were enrolled in the intervention and comparison groups, respectively. The primary outcome is a binary variable derived from the quality score, coded 1 (yes) for women with at least 75% of the total score and 0 if not. Data were collected electronically using tablets by directly interviewing the women and by extracting data from ANC registers, delivery registers, ANC cards, and health care records. The study procedures were standardized across all sites. We will compare unadjusted and adjusted primary outcome results (ANC quality scores) between the 2 study arms. We added a qualitative evaluation of the implementation of the PANDA system to identify barriers and catalysts. We also included an economic evaluation to determine whether the PANDA strategy is more cost-effective than the usual ANC strategy. The enrollment ran from July 2020 to January 2021 due to the COVID-19 pandemic. Data collection ended in September 2022. Data analyses started in January 2023, ended in June 2023, and the results are expected to be published in February 2024. The PANDA system is one of the most comprehensive apps for ANC because it has many features. However, the use of computerized systems for ANC is limited. Therefore, our trial will be beneficial for evaluating the intrinsic capacity of the PANDA system to improve the quality of care. By including qualitative research and economic evaluation, our findings will be significant because electronic consultation registries are expected to be used for maternal health care in the future in Burkina Faso. Pan-African Clinical Trials Registry (PACTR) PACTR202009861550402; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=12374. DERR1-10.2196/37136.

Mortality rates among children with CHD have significantly declined, although the incidence of neurological abnormalities and neurodevelopmental impairment has increased. Research has focussed on outcomes, with limited attention on prevention and intervention. Although some developmental differences and challenges seen in children with CHD are explained by the cumulative effect of medical complications associated with CHD, many sequelae are not easily explained by medical complications alone. Although cardiac intensive care is lifesaving, it creates high levels of environmental and tactile stimulation, which potentially contribute to adverse neurodevelopmental outcomes. The therapeutic method of individualised developmental care, such as the Newborn Individualized Developmental Care and Assessment Program, provides early support and preventive intervention based on each child’s behavioural signals of stress, comfort, and strength. Implementing developmental care practices in a cardiac ICU requires a thoughtful and well-planned approach to ensure successful adoption of practice changes. This paper reviews how developmental care was introduced in a paediatric inpatient cardiac service through multidisciplinary collaborative staff education, clinician support, child neurodevelopment assessment, parent support, and research initiatives. Given the known risk for children with CHD, cardiac medical professionals must shift their focus to not only assuring the child’s survival but also optimising development through individualised developmental care in the cardiac ICU.

Aim To assess nurses’ ability to observe newborn behaviour after in situ training provided by caregivers with advanced practice certification in the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Design Prospective observational study. Methods Twelve nurses viewed 20‐min films showing the behaviour of 10 premature newborns before, during and after the usual caregiving. The behaviour was rated on an observation sheet with 88 items distributed into six systems. The responses were compared to the reference ratings established by two professionals certified for this programme. Results Despite less accurate observations during care and for some components, the nurses generally showed a satisfactory ability to observe newborn behaviour after training by NIDCAP expert professionals. The dissemination of observation skills among caregivers may result in an improved quality of patient care and better communication among professionals in a department of neonatology.

Objective: Few tools have been optimised for use over the entire spectrum of neonatal morbidity and standardised for use in perinatal population and community health studies. The objective of this study was to determine the performance profile of the recently developed morbidity assessment index for newborns (MAIN score). This score was designed as a discriminative index of morbidity for the entire population of babies delivered >28 weeks gestation without a major congenital anomaly. Design and setting: MAIN score items were extracted retrospectively from the health records of 2892 consecutively born babies delivered beyond 28 weeks gestation in Edmonton area hospitals between June and December of 1999. Main results: The mean MAIN score in the general newborn population was 70.3 (95% confidence intervals 64.2 to 76.4). With the MAIN score tool, 84.6% of newborns scored from 0 to 150 (no/minimal morbidity), 11.3% from 151 to 500 (mild), 3.1% from 501 to 800 (moderate), and 1% had >800 (severe) score. The MAIN score tool was sufficiently sensitive to detect significant effects of low gestational age, low birth weight, male sex, caesarean delivery, tertiary hospital delivery, twins/triplets, non-vertex presentation, prenatal illicit drug use, and medical complications of pregnancy. Conclusion: The MAIN score fulfills the need for a simple, universal, yet sensitive and robust tool to provide a numerical index of early neonatal outcomes of prenatal care and adverse prenatal exposures in babies delivered beyond 28 weeks gestation. The performance of the MAIN score agrees well with the current medical awareness regarding the impact of adverse prenatal exposures on newborn morbidity.

Theme: Complex health care and chronic disease management. In 2003, a group of professionals from Oporto went to Boston in the United States in order to get to know the NIDCAP program and brought it to Portugal, because they believed that individualized care is the adequate response to the developmental needs of preterm babies and their families, a concern of the unit since its inception. The healthcare professionals were certified in the program, which began at the unit on 11 June 2011. Since then a better support system was provided to both families and professionals through systematic observations that provide guidelines for care, based on interpretation of the signs that preterm babies show. On 1 April 2015 the São João NIDCAP Training Center opened, the only Portuguese-speaking center in the Federation, providing training to healthcare professionals working in NICUs. We intend to present this journey and the benefits it brought to the Hospital São João's NICU.