Dr. Sachin Dangi Post graduate student, Department of Pediatrics - PowerPoint PPT Presentation

Dr. Sachin Dangi Post graduate student, Department of Pediatrics Pt. B D Sharma PGIMS Rohtak, Haryana. Co-authors: Dr. Poonam Dalal, Dr. Geeta Gathwala

 Very low birth weight (VLBW; <1500g birth weight) infants represent only 1.5% of all live births.  Very low birth weight newborns have excess morbidity and mortality, compared with newborns born at a normal weight.  VLBW newborns, which is often associated with preterm birth, remain a high risk population following discharge from the NICU.

 Very low birth weight infants who survive are at a significantly increased risk of severe health and developmental problems.  With the advances in neonatal care, the number of very low birth weight newborns who survive and are discharged from the NICU continues to increase.  These NICU graduates are at increased risk for readmissions to the hospital, with reported rates of readmission from 10 to 20%.

 In India there are only few studies about the outcome in newborn babies once they are discharged from NICU but there is no study on quality improvement intervention in form of comprehensive discharge counseling to reduce post discharge mortality & morbidity among VLBW newborns discharged from NICU.

 AIM- To evaluate the effect of comprehensive counseling on pattern of post discharge mortality and morbidity among VLBW babies.  OBJECTIVES 1. To find out causes and rates of readmission in very low birth weight newborn babies treated in neonatal intensive care unit before and after introduction of comprehensive structured counseling. 2. To evaluate mortality and morbidity pattern in newborn babies discharged from neonatal intensive care unit before and after introduction of comprehensive structured counseling.

 Study setting: Study was conducted in the neonatal services division, department of pediatrics, Pt. B.D.S. PGIMS, Rohtak, Haryana.

 Study design: Prospective observational study  Study Period: November 2017 to July 2018.  Consent : An informed written consent was obtained from the parents/legally acceptable representative (LAR) of all the enrolled neonates.  Ethical clearance : It was obtained from Institutional Ethics Committee (IEC) before commencement of study.

 Inclusion criteria: ( 1) Newborn babies admitted to NICU and discharged from NICU. (2) Birth weight less than 1500gm (VLBW).

 Exclusion criteria:  Parents/legally acceptable representative (LAR) not giving consent to participate in study.  Newborn babies who left follow up in neonatal follow-up clinic.  Neonates who were discharged on LAMA basis.  Babies with gross congenital malformation.

Second Second 3 months s of 3 m The study was divided into 3 periods of 3 months each. Last 3 months First 3 months Second 3 months  Routine protocol and existing practices of  Interventional tool in form of  Interventional tool in discharge/follow up structured comprehensive form of structured were continued. counseling was introduced at comprehensive counseling  All babies were was continued. the time of discharge of infants.  However, further babies  All babies were followed up followed up till were not enrolled in the chronological age of 3 till chronological age of 3 study in this period. months. months. Any events of mortality or Follow up of babies enrolled in Any events of mortality or the 2 nd period were continued morbadity/rehospitalization morbadity/rehospitalization till chronological age of 3 was recorded. was recorded. months.

The components of the interventional tool were:  One to one counseling of the mother and caregiver about the post discharge care of newborn, to address their concern and apprehension about handling a small baby.  A brief 10 minute video film on KMC was shown to the mother at time of discharge on the benefits of KMC.  Audio-visuals in the form of a brief power point presentation about baby care, feeding, temperature maintenance, KMC and danger sign was shown.  Brochures in simple language regarding post discharge care, follow up and danger sign were also provided to mothers at time of discharge.

 All data were entered in Microsoft Excel and analysed by using SPSS 15.0 version.  All categorical variables were expressed as number (%), all continuous variables were expressed as Mean ±SD.  Outcome variables were compared between the two groups by using Student t-test and chi-square test.  A p value <0.05 was considered as significant.

A total of 132 babies were enrolled during the study period CONTROL GROUP STUDY GROUP  64 neonates enrolled in  68 neonates enrolled in 2 nd first three months three months of study period 1 neonate was lost to followup 1 neonate was lost to followup Control Study Group- 63 group- 67

 10 newborns (14.7%) in the study group were readmitted after discharge as compared to 21 newborns (32.8%) in the control group.(P<0.05) Diagnosis Of Rehospitalized Babies 8 7 6 5 4 Study Group Control Group 3 2 1 0 Definite sepsis (Blood Culture RTI/Pneumonia Acute Gastroenteritis Others Clinical Sepsis Meningitis Intracranial Bleed Positive)

 Incidence of morbidities after discharge, was significantly less (p<0.05) in study group as compared to control group. 10 9 8 7 6 Study Group 5 Control Group 4 3 2 1 0 Loose stools Fever Weight loss/ Inadequate Difficulty in breathing Poor feeding Seizure Weight gain

 Number of newborns expired during follow up were 2 (3%) in study group as compared to 5 (7.9%) in control group.(p>0.05)  There was significant difference in mean weight gain and length gain between the two groups. 1. Mean weight at 3 month of age was (3.60 ± 0.21kg) in study group and in control group it was (3.23 ± 0.29kg).[p<0.05] 2. Mean length at 3 month of age was (48.11 ± 0.7cm) in study group and in control group mean length was (47.81 ± 0.8cm).[p<0.05]

Parameters of Newborns Care Provided At Home 70 60 50 40 Study Group 30 Control Group 20 10 0 KMC at Home Hand Hygiene Practices Observed Ability To Assess Temprature Maintenance There was significant improvement in hand hygiene practices, KMC rate and temprature maintenance.

 This study was conducted only in one hospital. Therefore, the generailzability of findings needs caution and more studies.

 The application of structured comprehensive counseling at time of discharge had a positive effect on morbidities and mortality among very VLBW babies after discharge from NICU.  Application of this simple tool could therefore help in improving post discharge morbidities and mortality pattern in neonates.  More study is warranted to determine if these results can be applied to multiple sites in more diverse populations.