RESUMEN
The International Fetal and Newborn Growth Consortium for the 21(st) Century (INTERGROWTH-21(st) ) is a large-scale, population-based, multicentre project involving health institutions from eight geographically diverse countries, which aims to assess fetal, newborn and preterm growth under optimal conditions. Given the multicentre nature of the project and the expected number of preterm births, it is vital that all centres follow the same standardised clinical care protocols to assess and manage preterm infants, so as to ensure maximum validity of the resulting standards as indicators of growth and nutrition with minimal confounding. Moreover, it is well known that evidence-based clinical practice guidelines can reduce the delivery of inappropriate care and support the introduction of new knowledge into clinical practice. The INTERGROWTH-21(st) Neonatal Group produced an operations manual, which reflects the consensus reached by members of the group regarding standardised definitions of neonatal morbidities and the minimum standards of care to be provided by all centres taking part in the project. The operational definitions and summary management protocols were developed by consensus through a Delphi process based on systematic reviews of relevant guidelines and management protocols by authoritative bodies. This paper describes the process of developing the Basic Neonatal Care Manual, as well as the morbidity definitions and standardised neonatal care protocols applied across all the INTERGROWTH-21(st) participating centres. Finally, thoughts about implementation strategies are presented.
Asunto(s)
Cuidado del Lactante/normas , Enfermedades del Prematuro/terapia , Estudios Multicéntricos como Asunto/normas , Guías de Práctica Clínica como Asunto/normas , Proyectos de Investigación/normas , Desarrollo Infantil , Protocolos Clínicos , Técnica Delphi , Femenino , Desarrollo Fetal , Estudios de Seguimiento , Gráficos de Crecimiento , Humanos , Cuidado del Lactante/métodos , Recién Nacido de Bajo Peso , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/diagnóstico , Manuales como Asunto , Estudios Multicéntricos como Asunto/métodos , Atención Perinatal/métodos , Atención Perinatal/normas , Embarazo , Nacimiento Prematuro/prevención & controlRESUMEN
The African site in the INTERGROWTH-21(st) Project was Parklands, a wealthy suburb of Nairobi, Kenya, with a largely middle-to-high socio-economic status population. There are three hospitals with obstetric units in Parklands, with approximately 4300 births per year. The Newborn Cross-Sectional Study (NCSS) sample was drawn from all three hospitals, covering 100% of births in this target population. The Fetal Growth Longitudinal Study (FGLS) sample was recruited from antenatal clinics serving these hospitals, using the eligibility criteria in the INTERGROWTH-21(st) protocol. Special activities to raise awareness of the study included securing media coverage and distributing leaflets in antenatal clinic waiting rooms. FGLS required women to be recruited in the first trimester; therefore, a major challenge at this study site was the high background frequency of first antenatal consultations in the second trimester. The problem was overcome by the study awareness campaign, as a result of which more women started attending antenatal care earlier in pregnancy.
Asunto(s)
Desarrollo Infantil , Desarrollo Fetal , Gráficos de Crecimiento , Recién Nacido/crecimiento & desarrollo , Estudios Multicéntricos como Asunto/métodos , Proyectos de Investigación , Pesos y Medidas Corporales , Protocolos Clínicos , Estudios Transversales/métodos , Femenino , Humanos , Lactante , Recien Nacido Prematuro/crecimiento & desarrollo , Kenia , Estudios Longitudinales/métodos , Selección de Paciente , Embarazo , Relaciones Públicas , Ultrasonografía PrenatalRESUMEN
Severe congenital skin abnormalities are a rare event. This case is unique in that it is a case of harlequin ichthyosis in sub-sahara Africa in a child of African origin and elaborates the challenges faced in its management. We present a neonate who was managed for this condition at Chogoria Mission Hospital. In presenting this case, we aim to sensitise healthcare providers to promptly recognise and manage this rare skin condition.