Wrapping premature infants with gestational age <34 weeks in polyethylene plastics immediately after birth is associated with lower incidence of hypothermia.

Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. MethodsWe did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. FindingsWe included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58•0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2•8 kg (2•3-3•3). Mortality among all patients was 37 (39•8%) of 93 in low-income countries, 583 (20•4%) of 2860 in middle-income countries, and 50 (5•6%) of 896 in high-income countries (p<0•0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90•0%] of ten in lowincome countries, 97 [31•9%] of 304 in middle-income countries, and two [1•4%] of 139 in high-income countries; p≤0•0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2•78 [95% CI 1•88-4•11], p<0•0001; middle-income vs high-income countries, 2•11 [1•59-2•79], p<0•0001), sepsis at presentation (1•20 [1•04-1•40], p=0•016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1•82 [1•40-2•35], p<0•0001; ASA 3 vs ASA 1-2, 1•58, [1•30-1•92], p<0•0001]), surgical safety checklist not used (1•39 [1•02-1•90], p=0•035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1•96, [1•4...

The Bilicheck is not a substitute for measuring serum bilirubin. However, using predetermined TcB cut-off values with reasonable sensitivity and specificity, it is a useful screening tool to identify infants with TSB>or=300 micromol/L requiring blood sampling, hospital admission and treatment.

Combined use of polyethylene body wrap and polyethylene cap was associated with a significantly higher mean post-stabilization temperature compared with polyethylene body wrap and cotton cap.

Objective: To determine the trend in incidence of preterm birth over five years and its predictors in a single centre.Design: A cross sectional study using electronic data from a Total Hospital Information System (THIS) and computerized birth registry system.Setting: A single teaching and referral hospital in the Greater Kuala Lumpur, Malaysia.Population or Sample: All livebirths delivered in the centre from January 2011 to December 2015 weighing ≥500g.Methods: Logistic regressions with backward likelihood ratio were used. Main outcome measures: Preterm live birth and live term babies.Results: 31,405 live births were included. There was almost 20% increment in the incidence of preterm births between 2011 and 2012 which then gradually decreased until 2015. Maternal age of 20-34 years (OR 0.7, 95% CI 0.7-0.8) was noted as a protective factor. The highest risk level of the pregnancy (OR 2.83, 95% CI 2.3-3.4), multiple pregnancy (OR 2.2, 95% CI 1.8-2.6), low birth weight (OR 18.7,) and male infant (OR 1.3, 95% CI 1.2-1.5) were noted as risk factors. Conclusions:The incidence showed an upward trend between 2011 and 2012 then a gradual decrease until 2015 with a similar pattern reported by national data. The predictors of preterm birth in the study centre were birth weight, risk level of the pregnancy, multiplicity of pregnancy, maternal age and infant gender. Continuum of care using the risk level coding assessment must be enhanced at the primary care level especially for appropriate referral and co-management at a referral centre (secondary or tertiary hospital).