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ANNEXURE – I: ETHICAL CLEARANCE CERTIFICATE
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ANNEXURE – II: INFORMED CONSENT FORM
Informed Consent Form for participation in Research
Title: “Studies of Transitional Adaptation (Cardiopulmonary Physiology) in
babies born at Hospital and those born at Primary Health Centers and Homes in
Rural villages”
Investigator: Dr Manisha Bhandankar, Assistant Professor
Department Of Pediatrics, JN Medical College, Belgaum
Supervisor: Dr V D Patil, Professor of Pediatrics
JN Medical College, Belgaum
Objective/Purpose of the study:
Many changes take place in the body functions of the babies immediately after
birth. The first cry indicates that baby is breathing on its own. Baby’s skin color
changes from blue to pink as the baby starts breathing regularly. Fortunately in most
babies these changes occur smoothly. If the baby is unable to establish normal
respiration and heart rate it may lead to difficulties requiring treatment. The purpose
of this study is to monitor changes that occur in a normal newborn immediately after
birth till first three days of life.
Procedure:
We want to understand how babies born in our hospital /homes adjust their
body functions by measuring Heart Rate, respiratory rate, Blood pressure,
temperature and Oxygen saturation (level of oxygen in body) using instruments
attached to baby soon after birth. They will be attached to hand/foot and abdomen
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without causing any hurt to your baby. Information gathered will be stored in the
computer and analyzed. We will also examine the baby regularly during this period.
Additionally, we will take small drops of blood by heel prick four times during this
study period.
Risks and Benefits:
Standard precautions will be taken during application of the monitoring
equipments and while collecting the blood samples. We understand that newborn
babies are special and vulnerable group and utmost care needs to be taken during the
procedure. Please understand that information gathered from your baby will be
extremely important to understand how babies adopt to environment after birth and if
they develop difficulties how we can help them better adopt to home/hospital
conditions. This will not only help your baby but many other babies. It will prevent
many potential deaths in future.
Institutional/sponsors Policy:
If the baby develops any problem during the study period baby will be treated
without delay as necessary. You will not be charged for the monitoring done for this
study.
Alternatives:
Your participation in this study is completely voluntary. You may withdraw
from the study any time for any reason and it will not affect the care given to you and
your baby.
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Financial incentives for Participation:
You will not be charged for these studies. Also you will not be paid any form
of incentive to participate in this study.
Authorisation to publish results, Privacy and Confidentiality:
The results of this study may be published for public interest and scientific
purpose. However your name will not be identified and confidentiality of the data will
be maintained. Only Dr V D Patil Professor of Pediatrics and Principal JN Medical
College, Dr D Vidyasagar, Professor of Pediatrics, University of Illinois, Chicago,
Illinois and Dr Manisha Bhandankar, Assistant Professor, Department of Pediatrics
JN Medical College, Belgaum will have excess to the data.
In case of emergency you may contact Dr Manisha Bhandankar Mobile No:
9845946230 .
If you have any questions about this study or need any information regarding
your right to participate in the study you may please contact Dr V D Patil, Professor
of Pediatrics JN Medical College and Supervisor for this study, mobile no
9448190231.
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Consent Statement:
I have read the information given above/it has been read to me in vernacular
language. All the information regarding this study has been provided to me and I have
understood the same. I have been given the opportunity to ask questions and got
appropriate answers. I give my consent voluntarily without any force/pressure for
participation of my baby in this study.
Name of the Parent Signature or left hand thumb impression of the parent
Name of investigator Signature of investigator
Name of witness Signature of witness
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ANNEXURE – III:A. DATA COLLECTION FORM (BABY)
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ANNEXURE – III:B. DATA COLLECTION FORM (MOTHER)
IPNo. (Where Applicable) :
Mother’s Name :
Father’s Name :
Address :
Income Education Occupation
Father
Mother
Socio-Economic Status : Upper / Middle / Lower
Mother
Name : Age : ____Yrs. Weight : Kgs.
Booked/UnBooked G : Para: A: L:
LMP: EDD: Blood Gr. Hb.: B.P._____,_____
Past Obstetric History :
Present Pregnancy
History :
USG :
Baby
DOB : TOB : Male /
Female
Wt. Kg
Gestation By Dates :
weeks
Gestation By Examination :
weeks
First Cry At : min /sec
Apgar Score : 1 min ________ 5 min ________ 10 min ________
Examination
Birth
Injury
Mouth
&
Nose
Chest CVS Abdomen Genitalia Limbs Hips Anal
Patency
Other
Findings
Resuscitation :
Labor & Delivery
On set : Delivery : Duration :
Fetal Distress Yes / No HR (Range) : PROM :
Monitoring (Where Applicable)
NST Type Of Dips : USG Doppler :
Medications(Where Applicable)
Oxytocin : Others :
Time Of Cord Ligation :
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ANNEXURE – IV: PUBLICATIONS AND PRESENTATIONS
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DIFFERENCES IN THERMAL ADAPTATION OF INFANTS DELIVERED
AT PRIMARY OR TERTIARY CARE FACILITIES IN INDIA
Manisha Bhandankar, MD MRCPCH, V. D. Patil MD
Department of Pediatrics, KLE University’s JN Medical College
Belgaum, India
&
Dharmapuri Vidyasagar, MD
Emeritus Professor, Pediatrics
Division of Neonatology
University of Illinois at Chicago Medical Center
840 South Wood Street, M/C 856
Chicago, Illinois 60612 (USA)
Email: dvsagarmd@yahoo.com
Office: (312) 996-4185
Fax: (312) 413-7901
Funding: None
Corresponding author: Dharmapuri Vidyasagar, M.D.
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ABSTRACT:
Background: Studies in developing countries, including India, have demonstrated
high incidence of hypothermia in neonatal period.
Objectives: To compare the pattern of thermal stabilization seen in infants born at a
rural Primary Health Center (PHC) with that of infants born in an modern urban
Tertiary Care Hospital (TCH).
Methodology: Abdominal temperature (Ta) and foot temperature (Tf) of healthy term
newborn infants were monitored and electronically recorded continuously from birth
in the delivery room (DR) until12 hours of life in the postnatal ward (PNW) at two
sites. Seventy one infants were enrolled in the study: 51 infants at the PHC and 20
infants at the TCH.
Results: In infants delivered at TCH the maximum mean (SD) Ta of 36.40C (0.48)
was reached by 12 hours while at PHC maximum mean Ta was 35.40c (1.98) by 10.5
hours .The mean Tf improved from the lowest value of 29.70C (1.3) at 4.5 hours to
32.90C (1.6) by 12 hours of life in infants delivered at TCH while in infants delivered
at PHC Tf remained low (max 30.70C) all through 12 hours. The mean Td (Ta-Tf)
gradually decreased from a maximum of 5.90C (1.6) at 4.5 hours to 3.5
0C (1.5) by 12
hours of life in infants born at TCH but the Td remained at > 50c even after 6 hours of
life in infants born at PHC which was statistically significant (P<. 05). The calculated
area between the Ta and Tf, a proxy for metabolic stress was greater in babies born at
PHC than those born at TCH.
Conclusions: Our study shows that although both groups of newborn infants
experienced significant thermal stress, infants delivered at PHC experienced
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significantly greater thermal stress than babies born at TCH. This difference could be
attributed to differences in thermal environment of DR and PNW between PHC and
TCH.
Key Words: Newborn infant, Hypothermia, Thermal Stress, Primary Health center
INTRODUCTION:
Hypothermia is a major cause of neonatal morbidity and mortality. Several
previous studies have shown the adverse effects of hypothermia on increased
metabolic stress and compromise in extra uterine physiologic adaptation.1-5
These
studies were mainly carried out in a controlled optimal environment.6- 8
In contrast, in
developing countries the environment in the delivery rooms is uncontrolled.9, 10
Studies in developing countries, including India, have demonstrated high incidence of
hypothermia in neonatal period.9-13
.However there are little data regarding the thermal
changes in the immediate newborn born period in infants delivered in tertiary and
rural health care facilities in resource poor countries. The purpose of this paper is to
present the comparative data of thermal adaptation of newborns born in an urban well
equipped tertiary care hospital (TCH) and newborns born at a rural Primary Health
Center (PHC) in India, a resource poor country.
METHODS:
The internal review board of the KLE University, Belgaum, India, approved
the study protocol. Written consent of mothers without high risk factors was obtained
prior to delivery for enrollment of their babies into the study at both sites.
At both sites the monitoring methods were similar. After vaginal delivery, the
right palm was dried and saturation probe was attached. After complete drying of the
baby, temperature probes were attached at two different sites. The central skin
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temperature probe was placed on the right hypochondrium just above the umbilicus.
The peripheral temperature probe was attached to the sole of the foot above the heel
and was secured in place using Micropore tape. We used YSI 427/729(Dayton, Ohio
45440, and USA) reusable pediatric skin temperature probes with accuracy of ±0.150
C. These temperatures, SpO2 and heart rate were recorded simultaneously using a
Planet 55 4 channel multi-recorder (L& T Company, Mysore, India). Battery back-up
assured continuous uninterrupted recording. Recording began in the delivery room
and completed up to 12 hours later in the postnatal ward. Each value was averaged
and recorded at 5 seconds intervals. Additionally, at both sites we monitored room
temperature and humidity in the DR and the postnatal ward (Thermo-Hygro clock
MEXTECH M288CTH Japsin Instrumentation, India) at regular intervals.
Infants born at term by normal vaginal route without antenatal and intranatal
risk factors were included in the study. Inclusion criteria of infants into the study
were: 1) Full term infants born by normal vaginal route, 2) Infants who did not require
resuscitation at birth 3) Infants with no congenital anomalies, 4) Birth weight >2,200
grams. At the TCH, after delivery the infants were placed under a radiant warmer
and care was given as per NRP guidelines14
. The TCH postnatal ward was a general
60 bed open room for mothers and newborns with no air conditioning or central
heating system. Windows of the unit were open or closed depending on the weather
conditions.
The PHC is located 22 Km from the TCH and is a teaching affiliate. The
single delivery room was equipped for vaginal deliveries with a resuscitation trolley
including oxygen and bag/mask resuscitation capability and vacuum suction. The
postnatal recovery area consists of a general ward with 6 beds. Training of staff was
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similar to the TCH and included assurance of quality recording techniques and
adherence to the protocol before enrolling study subjects.
After delivery at the PHC the newborn infant was dried, wrapped in a cloth,
moved to the general ward, and the various sensors were then attached as described
for the TCH. The mother was moved to the ward about 30-45 minutes later and
mother baby dyad was co bedded similar to TCH.
All infants were exclusively breast-fed on demand. As per traditional practice
in both environments the newborn infants were not clothed (no shirt, cap or socks) but
they were wrapped in a cloth and remained under a cover shared with the mother.
Change of wet and soiled clothing was done as needed.
Data Analysis:
Data were transferred to an Excel spreadsheet program (Microsoft, WA,
USA). For analysis we included only those tracings that had data starting within 5
minutes of birth in the TCH and 10 minutes of birth in the PHC and continued till 12
hours of life.We excluded readings from analysis when the probes were found to be
displaced. There were no failures because of power interruption.
Data were merged and analysed using SPSS version 16.0. All values are
reported as mean and standard deviation (mean ± SD). We calculated abdominal (Ta)
and foot (Tf) temperature every 5 minutes for the first 2 hours after delivery and then
every 15 minutes until completion of the recording. We compared the data using
unpaired Student t test where appropriate. P ≤ 0.05 was considered to denote
significant difference between groups.
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RESULTS:
Differences between the two sites in regards to infant care capabilities are
highlighted in Table 4. The personnel at the TCH had Pediatrics specialty training,
electricity was continuously available, postnatal care occurred in a dedicated PNW
with environmental controls, a radiant warmer and warmed towels were available for
postnatal use. Also the TCH infants initiated breast feeding and maternal contact
earlier after birth. At the TCH, initially infants were wrapped in a cloth; sensors
applied and kept under a warmer. While still in the delivery room infants were given
to the mother for breast-feeding at age 0.75 ± 0.5 hrs and remained with mother until
transfer to the postnatal ward (PNW). Transfer occurred at 2.5 ± 0.8 hours from birth
and required 15±8 minutes.
Of the 30 infants enrolled at TCH 8 infants were excluded from study due to
inadequate data collection or technical difficulties in data collection Additionally 2
parents did not give consent to continue monitoring for 12 hours. Data of the
remaining 20 infants are included in the analysis.
At PHC we enrolled 61 newborn infants into study of whom 8 infants were
excluded from the study analysis due to inadequate data collection or technical
difficulties in data collection, 2 infants were excluded because of birth weight <2200
grams. The data of the remaining 51 infants were used for analysis.
Demographic profiles of the two study groups are shown in table 1. Infants
enrolled into both groups had comparable gestational age and birth weights. Table 2
shows data on room temperature and humidity in the DR and PNW in the TCH. There
were no significant differences in room temperature and humidity between the
delivery room and postnatal ward at TCH. At PHC the delivery room and postnatal
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ward were adjacent to each other and temperature and humidity ranged were not
different.
Fig 1 shows the trends of Ta and Tf in among babies studied at TCH. In DR
the mean Ta was 34.620C ±0.69 at 5 minutes and reached maximum 35.9
0C ±0.60 at
2hrs of age. Whereas mean Tf dropped precipitously to 30.30C ±1.57 by 2.5 hours. Tf
declined even further after transfer to PNW reaching mean 29.70C ±1.33 and mean Td
(difference between Ta &Tf) of 5.940C ±1.39 at 4.5 hrs age. Thereafter Tf gradually
improved to mean 32.90C ±1.63 at 12hrs. Mean Ta reached 36.020C ±0.44 at 8 hours
of age. The minimum Td occurred at 5 minutes, increased gradually to maximum of
5.560C ±1.53 by 2.45 hours in DR & then decreased to 3.35
0C ±1.49 by 12 hours.
Fig 1also shows Ta and Tf of babies studied at PHC. Mean Ta increased
gradually from 33.50C±1.75 at 10 minutes to 34.5
0C±1.55 when the baby was
wrapped in dry cloth. After a slight drop by 0.50C in next 15 minutes, there was a
steady rise in temp to reach maximum of 35.50C±1.98 by 10.5 hours of age. There
was no further rise in mean Ta till 12 hours. During the same period, Tf gradually
declined from 30.30C±1.24 at 10 minutes to 29.2
0C±0.74 in first 3.5hours and then
remained in the range of 29.5-30.7oc until 12hours of age.
When individual trends for the PHC infants were analyzed only 15/51 (30%)
infants showed abdominal skin temperature above 360c between 6-12 hours but did
not maintain this temperature consistently. Maximum mean Td was 5.50C and it
remained in the range of 5-5.90C from 2-12 hours. 85% of infants reached a stable Ta
above 36.0oC maximum by 8 hours of age and maintained this temperature until 12
hours.
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The PHC Ta values were consistently lower than those observed in babies
studied at TCH and this difference between the groups was consistently 1.50C through
the study. These differences suggest that babies born at PHC had a relatively lower
core temp compared to babies born at TCH.
Table 2 gives the data points at specific times from birth in both groups. The
data show that both Ta and Tf were lower in infants cared for at PHC (P<. 05) than
those infants cared for at TCH. It also shows that Ta and Tf of infants at PHC
continued to stay significantly lower (P<. 05) than the Tf of infants cared at TCH
except for difference in Tf and Td at 2 hours and 6 hours.
Among the TCH group 9(45%) attained Ta of 360 C by 2 hours of age, but
among the PHC infants only 6/51 (15%) infants attained that Ta in the same time.
85% of infants delivered in TCH reached a stable Ta above 360C maximum by 8
hours of age and maintained this temperature until the end of the recording period.
However only 29.5% of the infants born at PHC achieved and maintained temperature
above 360 C during the study period. Of the 6 low birth weight (2,200-2,500grams)
PHC infants only 2 had achieved Ta 360C by 2 hours of age.
We assumed that the area between Ta and Tf over a unit time serves as a
proxy to metabolic stress in the baby.The area between Ta and Tf from birth to 12 hrs
age was calculated using the trapezoidal rule. The difference between Ta and Tf (Td)
and the Area between Ta and Tf curves obtained from two sites was calculated and
compared. The mean Td (SD) of 4.80 C (0.83) in TCH group was significantly lower
(P<. 002) than the mean Td (SD) 5.40 C (0.39) of PHC group. The Area between the
curves was also higher at PHC than at TCH.
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DISCUSSION:
Current information on incidence of hypothermia is based on studies
conducted in controlled environment of delivery rooms from the developed countries3-
6 and from a few other studies conducted in postnatal wards
9,10,13and communities of
developing countries. 17-22.
No information is available on thermal adaptation
immediately after birth of infants who are delivered in hospitals and PHCs in
countries with limited resources to maintain controlled room temperature and
humidity as per standard guidelines.21
We studied trends in thermal adaptation of newborns delivered and cared for
in a TCH and of infants delivered at a PHC using the same study protocol. Our
studies, which were initiated within minutes of birth continued until12 hours of life,
showed several differences in thermal adaptation of infants delivered at PHC
compared to those delivered at the TCH. Babies delivered at PHC had consistently
lower Ta, and Tf and took longer for Ta to reach 35.40C temperature (maximum mean
Ta), the mean Tf took longer to improve and remained lower than TCH babies even at
5 hours of age. Td all through study was significantly greater in PHC babies than
babies at TCH. Altogether babies at PHC experienced greater thermal stress. These
differences in thermal adaptation between infants born at PHC and those born at TCH
are of clinical importance as they may impact on neonatal morbidity and mortality.
Our findings are supported by previous studies of oxygen consumption and
heat loss using sophisticated metabolic studies. Malin and Baumgart 15
showed that
wider differences between skin temperature and rectal temperature indicated higher
oxygen consumption. In another study Karlsson and colleagues6 measured heat loss in
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the newborn at birth and showed that heat loss was directly proportional to
temperature differences between abdominal and rectal temperatures.
Other reports from developing countries have reported similar findings to
ours. In one village-based study in India, 11% of 189 neonates were found to be
hypothermic (<35.60C) based on a single temperature reading taken within the first 24
hours after birth.19
A recent community-based study in rural India showed the
prevalence of hypothermia (<36.50C) was high in both low birth weight (49%) and
normal birth weight (43%) infants.22
In Nepal, continuous ambulatory monitoring was
done starting within 90 minutes of birth. Mean core temperature of infants was found
to be less than 350C for 72% of the measurements in first 8 hours.
9 In a cross sectional
study done at a peri-urban hospital in Uganda 79% newborns were found to be
hypothermic at 90 minutes of age.20
In a study from Zambia 44% infants between 0-7
days of life were hypothermic at admission to hospital.21
A study done in a tertiary care hospital in India 13
showed that even during the
months of summer in May, when ambient temperature of maternity ward was
maintained between 26-280 C, nearly one fifth of the healthy term babies were under
cold stress as evidenced by greater than 20C difference between the core and
peripheral skin temperatures.
It is important to identify the factors responsible for the observed differences
in thermal adaptation of infant born at PHC. The study populations in the two groups
were similar in terms of gestational age, birth weight and clinical parameters. Also
both groups of infants were given standard newborn care. Thus observed differences
in thermal adaptation must be due to differences in other factors such as
environmental, equipment, infrastructure and clinical practices in maintaining thermal
neutrality during the immediate neonatal period. Table 4 gives the three major
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differences that were identified between the two sites: environmental temperature,
equipment and personnel skills.
It should be noted that there is no mechanism to maintain WHO
recommended23
room temperature at either site. In the PHC a radiant warmer was
available, but not frequently used due to interrupted power supply. In addition there
was no separate room to care for the mother and baby dyad. The medical staff nurses
at PHC are trained but not skilled to provide newborn care and are burdened with
multiple responsibilities. Finally cultural practices of not using caps and shirts for first
five days add to the risk of hypothermia. Mothers and families usually are not
prepared in advance to PHC.
We recognize several limitations of this study. The primary investigator (MB)
could not be present at PHC for delivery of all babies included in the study to monitor
each case completely. This was impractical because of unpredictability of deliveries
and the distance involved. However we engaged committed medical staff and health
workers who were trained to collect quality data and were under the constant
supervision of the investigator. Since the PHC serves as a teaching unit the medical
staff particularly the resident staff was well acquainted with the routine procedures of
newborn care followed at TCH.Even though supply of electricity was often
interrupted our recording equipment was supported by an uninterruptable power
supply. The relatively short distance of 22 Km was also easy for frequent visits by
the investigator.
The findings of our study are of special importance in view of recent
Government of India policy to increase deliveries at PHCs. As per the Indian Public
Health standards (IPHS), PHCs are expected to provide 24 hours delivery services,
along with newborn care services.24,25
Scaling up of neonatal care through data driven
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decision making process is necessary to improve neonatal outcome.26
India is still not
on track to achieve the Millennium Development Goal 4 by 2015. It is therefore
essential to recognize the knowledge gaps that are hindering the progress.27
Our study
indicates that there is a dire need to improve physical structure of PHC to provide
thermal neutral environment and the need for capacity building of staff at PHCs in
recognizing and managing thermal stress in newborns. Although PHCs may be
equipped with standard radiant warmers in the delivery rooms problems associated
with frequent power outages, lack of technical support and lack of staff training can
make them dysfunctional. Our studies underscore the need for rigorous
implementation of protocol-driven newborn care at all PHCs. The need for health
education to change traditional practices has already been identified in previous
studies.28, 29
CONFLICT OF INTEREST:
Authors declare that there was no conflict of interest with any equipment
manufacturers used in the study.
ACKNOWLEDGEMENT:We are immensely thankful to the staff nurses of the
Delivery room and Postnatal Ward of KLES Dr. PrabhakarKore Charitable Hospital
& MRC, Belgaum for the immense support provided for conducting this study. Dr.
SantoshTamgond, Registrar, Department of Pediatrics helped in initiating the
monitoring in DR. We would like to acknowledge the support and interest shown by
Dr. Saudagar and the rest of the staff of Kinaye PHC during training and later
conducting this study. Mr. Mallapure, Lecturer, JN Medical College, Belgaum and
Mr. S. Bhide helped with statistical analysis. Mr. Tejas Bengali, Assistant Manager -
Design & Development, L& T Company, Mysore, India provided technical guidance.
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26. Knippenberg R, Lawn J, Darmstadt G, Begkoyian G, Fogstad H, Walelign N
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FIGURE LEGEND:
Figure 1:The graph shows the temperature trends in Ta, Tf at PHC and TCH from
birth to 12 hours of age in babies born at THC and PHC. Note that Ta and Tf are
lower in babies born at PHC than TCH all through the study period. The Ta in both
groups starts lower then steadily increases. The area between Ta and Tf during the
study period reflects thermal stress.
Figure 1:
Table 1: Demographic profile of the infants in study group from TCH and PHC.
Site No & Gender Gest in Weeks Birth Weight (Grams)
TCH 6 Males
14 Females
38.7±1.1 2811±325
PHC 30 Males
31 Females
39.1±0.9 2754±256
28.0
29.0
30.0
31.0
32.0
33.0
34.0
35.0
36.0
37.0
38.0
0.2
0.5
0.8
1.0
1.5
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10
.0
11
.0
12
.0
T
e
m
p
0
C
Time from birth in hours
Ta(PHC)
Tf(PHC)
Ta(TCH)
Tf(TCH)
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182
Table 2: Mean(SD) of Ambient temperature and humidity at both sites.
Temp 0C & Humidity % in DR.
Mean(SD)
Temp0
C & Humidity % in
PNW Mean (SD)
TCH(N=20) Temp.:24.5(1.3)
Humidity:79(8)
Temp:25.36(1.14)*
Humidity:81.9(9)
PHC(N=51) Temp:24.2±1.67**
Humidity:83(6)
SD Standard Deviation
* Significant difference in ambient temp and humidity (P<.05) between DR and PNW
at TCH. Note that at PHC DR and PNW are adjacent to each other. Therefore only
one set of values are shown.
** Difference in ambient Temp between TCH/PNW and PHC was significant. P< .05
Difference in ambient humidity between TCH/PNW and PHC was not significant.
Table 3: Mean (SD) Ta, Tf& Td at TCH & PHC at specific time from birth
Ta 0c Mean(SD) Tf
0c Mean (SD) Td
0c Mean (SD)
Time
from
birth
TCH
N= 20
PHC
N=51
TCH
N=20
PHC
N=51
TCH
N=20
PHC
N=51
10 min 35.1(0.79) 33.5(1.7) 31.76(0.7) 30.32(1.4) 3.34(1) 3.54(1.7)
2 hours 35.9(0.6) 34.6(1.7) 30.5(1.4) 29.3(0.92) 5.34(1.4) 5.3(1.5)
6 hours 35.6(0.63) 34.8(1.2) 30.38(1.4) 29.3(0.8) 5.3(1.1) 5.5(1.1)
10 hours 36.1(0.52) 35.1(1.5) 32(1.26) 30.7(0.5) 4.03(1) 5.9(1.8)
SD Standard Deviation
There was statistical significant difference in Ta and Tf between TCH & PHC at each
time interval studied. (P<.05). But Td (Ta-Tf) was statistically different only at 10
hours between PHC and TCH. (Td 5.9 at PCH and 4.03 at TCH).
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183
Table 4: Differences Between Two Sites in Maintaining Warm Chain
TCH
PHC
Environment 1) Temp:23.5-27.50C,
Humidity:75-88%
2) Dedicated PNW, open
spacious ward with closed
windows
1) Temp:22.5-28.50C
Humidity:55-90%,
2) General ward open windows for
ventilation.
Equipment&
infrastructure
1) Radiant warmer available
2) Continuous electricity supply
3) Warm towel used to receive
baby.
1) Radiant warmer not available
2) Interrupted electricity supply 14- 18
hours a day
3) No warm towels were used.
Skilled
personnel
1) Pediatric resident to attend each
delivery
2) Adequate staffing in DR & in
PNW. Staff trained & skilled
in neonatal resuscitation and
essential newborn care.
1) General MD
2) Inadequate staffing, trained but not
skilled in neonatal resuscitation and
essential newborn care
Table Legends:
Table1; Gives the demographic profile of the infants in study groups from TCH
and PHC. The range of gestational age and birth weight are given.
Table 2; Gives the mean (SD) of temperature and humidity at both sites.
Table 3; Gives mean (SD) Ta, Tf& Td at TCH & PHC at 10 min, 2 hours, 6
hours and 10 hours of age.
Table4; Gives differences in environment, equipment, infrastructure and
clinical kills of available personnel at TCH and PHC.
Artcile submitted to Journal of Perinatalogy[#10-927-R] Nature Publishing Group,
USA. The revised article is in review process.
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184
POSTER PRESENTATION
1. Pediatric Academic society (PAS) meeting at Baltimore, USA May 2009.
The Pediatric Academic Societies (PAS) Annual Meeting is the largest international
meeting focusing on research in child health. The focus is on high quality original
research presentations through papers and posters in child health which are selected
by a panel of esteemed researchers and academicians in the field.
2. Poster Presentation at Pediatric Academic society (PAS) meeting at Baltimore, USA May
2009.
Annexures
185
3. Poster Presentation at Pediatric Academic society (PAS) meeting at Vancouver, May 2010
4.Poster Presentation at Pediatric Academic society (PAS) meeting at Vancouver, May 2010
5. Paper presentation :
1. National Neonatology Forum meeting at Ahmedabad , India December 2009 on “
Thermal Stress in newborns during Transitional Period: Birth to 12 hours of life”.
2. National Neonatology Forum meeting at Jaipur , India December 2010 on “ Differences in
thermal adaptation of infants delivered at Primary Health Center and those born at a tertiary
care hospital”.