BackgroundIndia has the highest number of preterm births and maximum number of deaths due to prematurity. Chengalpattu Government Medical College had 11 593 deliveries annually in 2020, of which 2252 of neonates were low birth weight. 2016 Cochrane review concluded that Kangaroo Mother Care (KMC) reduces the morbidity and mortality in low birthweight infants. The average duration of KMC in our unit was around 4.6 hours/baby/day.ObjectiveTo improve the duration of KMC in stable low birthweight babies from short duration to continuous duration (>12 hours) over 8 weeks.MethodsThe implementation phase was conducted during January 2021 and February 2021. All babies with birth weight <2 kg and who were haemodynamically stable were enrolled. QI (Qualitympovement) team included staff nurses, nursing in charge, resident doctors and consultants. Potential barriers were listed using fishbone analysis. Various possible interventions were identified and a priority matrix was formed to decide the sequence of introduction of changes. The following measures were subsequently tested by multiple PDSA (Plan Do Study Act) cycles: ensuring the availability of KMC charts, combining KMC chart with individualised weight chart, documentation of KMC duration in case sheets, increasing number of KMC chairs, opening of mother–neonatal ICU (M-NICU), KMC slings for mothers, education videos in local language and rewards for mothers.Outcome indicatorDuration of KMC, recorded by bedside nurses on daily basis.ResultsA total of 86 newborns were enrolled. At the end of 8 weeks, average duration of KMC increased to 16.6 hours/baby/day. The intervention which was most useful in increasing KMC duration was opening of M-NICU. We were able to sustain the improvement at the end of 6 months.ConclusionSequential measures taken as a part of QI initiative, helped to increase the average duration of KMC from 4.6 hours/day to 16.6 hours/day, without much additional resources.
Objective: To compare Fenton and Intergrowth-21st growth charts in assessing the growth pattern of preterm infants at birth and at discharge. Methods: This is a retrospective study conducted over a period of 1 year. The study included the neonates born at ≤34 weeks of gestation who are admitted and stayed for ≥14 days in our hospital. The data was collected from discharge sheets and electronic database. The weight of all babies at birth and at discharge was collected. Growth was assessed based on Fenton and Intergrowth-21st growth charts. The small for gestational age (SGA) was defined as birth weight ≤-1.28SD. The extrauterine growth restriction (EUGR) status of babies was assessed by a criteria of ≤-1.28SD at discharge. Results: Most common preterm phenotype was spontaneous preterm labor (47.4%), and the rate of singleton birth was 78.9%. The mean gestational age and birth weight of babies were 31.6±1.42 weeks and 1608.06±275 g, respectively. We found the rates of SGA in our group 15.2% and 13.5%, and appropriate for gestational age (AGA) 80.5% and 82.2%, respectively by using Intergrowth and Fenton growth charts. The EUGR rates in our group were 72.8% and 81.3%, respectively, on Intergrowth-21st and Fenton growth charts using a criteria of ≤-1.28SD at discharge. Conclusion: There is no statistical difference between Fenton and Intergrowth-21st charts in identifying SGA and EUGR. However, the rate of EUGR is higher in Fenton charts than intergrowth-21st charts.
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