RESUMEN
OBJECTIVE: To determine the effect of partial Kangaroo Mother Care (KMC) on growth rates and duration of hospital stay of Low Birth Weight (LBW) infants. DESIGN: Unblinded, randomised clinical controlled trial. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: Over a nine month period, consecutive recruitment of eligible LBW infants weighing 1000 g to 1750 g was done until a sample of 166 infants was reached. INTERVENTION: Kangaroo mother care was practised over an eight hour period per day for the intervention group while the controls remained in incubators or cots. Weight, head circumference, and mid upper arm circumference were monitored for all infants till discharge at 1800 g. RESULTS: Of the 166 infants recruited 157 were followed up to discharge. Baseline characteristics were similar for the two groups except for mother's age, with the KMC group mothers having a mean age of 26.5 years while the control group mothers had a mean age of 24 years, (p = 0.04). The KMC group had significantly higher growth rates as shown by the higher mean weight gain of 22.5 g/kg/day compared with 16.7g/kg/day for the control group, (p < 0.001); higher mean head circumference gain of 0.91 cm/week compared with 0.54 cm/week for the control group, (p < 0.001) and higher mean mid upper arm circumference gain of 0.76 cm/week compared with 0.48 cm/week for the control group, (p = 0.002). Although overall duration of stay was similar between study arms, when infants were stratified into those above or below 1500 g KMC infants' duration of stay was significantly shorter than those in regular care. Using logistic regression, KMCwas the strongest predictor formeanweight, meanhead circumference and mean MUAC gain while mother's age (older) was the strongest predictor for mean duration of stay with KMC being an independent predictor of duration of stay. CONCLUSION: Low birth weight infants in this cohort achieved rates of growth within the recommended intrauterine growth but babies managed using partial KMC grew faster and were thus discharged earlier than those on standard of care. Since partial KMC was beneficial, it should be fully implemented for all eligible infants.
Asunto(s)
Cefalometría , Recién Nacido de Bajo Peso , Recien Nacido Prematuro , Método Madre-Canguro , Tiempo de Internación , Aumento de Peso , Adulto , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Hospitales Universitarios , Humanos , Recién Nacido , Recién Nacido de muy Bajo Peso , Unidades de Cuidados Intensivos , Kenia , Masculino , Grosor de los Pliegues CutáneosRESUMEN
OBJECTIVES: To determine the incidence of neonatal acidaemia following delivery through caesarean section under spinal anaesthesia and determine the prevalence of maternal hypotension during Caesarean section under spinal anaesthesia and its correlation with neonatal acidaemia. DESIGN: Prospective observational study. SETTING: Kenyatta National Hospital (KNH), Nairobi, Kenya. SUBJECTS: One hundred and seventy-two ASA I and II consecutive term patients undergoing elective Caesarean section under spinal anaesthesia. RESULTS: Forty three babies (27.2%) were born with neonatal acidaemia, defined as umbilical arterial blood pH 7.2. There was, however, no significant difference in the five minute Apgar scores between the acidotic and non-acidotic neonates. Twenty eight patients (17.7%) developed maternal hypotension (systolic Blood Pressure less than 100mmHg). The hypotension was readily corrected within two minutes (mean of 1.43 minutes) of onset using vasopressors and boluses of intravenous fluids. CONCLUSIONS: A short period (< 2 minutes) mean of 1.43 minutes of maternal hypotension has no significant effect on the neonate as assessed by five minute Apgar Scores. Similarly, neonatal acidaemia following Caesarean delivery under spinal anaesthesia does not seem to have any short-term effects on neonatal well-being.
Asunto(s)
Acidosis/sangre , Anestesia Raquidea/efectos adversos , Cesárea , Concentración de Iones de Hidrógeno , Hipotensión/etiología , Hipotensión/terapia , Acidosis/epidemiología , Adulto , Puntaje de Apgar , Procedimientos Quirúrgicos Electivos , Femenino , Fluidoterapia/métodos , Hospitales Universitarios , Humanos , Concentración de Iones de Hidrógeno/efectos de los fármacos , Incidencia , Recién Nacido , Kenia/epidemiología , Embarazo , Prevalencia , Estudios Prospectivos , Vasoconstrictores/uso terapéuticoRESUMEN
OBJECTIVE: To compare the pattern of use of skin care products between children with eczematous skin lesions and those without. DESIGN: Case control study. SETTING: Two well baby clinics at the Kenyatta National Hospital and the Mbagathi District Hospital in Nairobi. SUBJECTS: Eighty nine infants with eczematous skin lesions and 89 age and sex matched controls without skin lesions. MAIN OUTCOME MEASURES: Presence and severity of skin lesions related to the type of skin care products used by the child. RESULTS: Exposure to various products was not significantly different between infants with skin lesions and those without. However, more mothers whose children had a skin rash had made a change in the type of soap and or skin cream used for their child (p<0.0001). The principal reason for changing products was skin rash in the baby and most mothers made changes away from scented baby soap products. CONCLUSION: The study found no significant difference between the cases and controls regarding the type of skin care products used.