exudates and Asphyxia-Neonatorum

The neonatal resuscitation programme (NRP) published by the American Academy of Paediatrics and American Heart Association was launched in Malaysia in 1996. This study aimed to review the outcome of NRP in Malaysia during the first eight years.. Information on basic demographical data and training activities of NRP providers were collected prospectively from NRP instructors from all over Malaysia during the eight years following the inception of the NRP. The national perinatal and neonatal mortality data during the five-year period before and eight years following implementation of the NRP were compared.. During the eight years following the launch, 14,575 personnel were trained. 40 percent of NRP-certified personnel worked in areas where delivery services were provided, viz. labour room, operation theatre, obstetric ward, emergency department and maternal and child health clinic. There were very few NRP-certified providers working in emergency departments and most of them were medical assistants. Most of the providers working in neonatal intensive care units (NICUs) and labour rooms were nurses while those in paediatric wards were doctors. All NRP-certified doctors working in NICUs and labour rooms obtained full certificates. Only 80 percent of NRP-certified nurses in these two areas obtained full certificates. There was further serial decrease in perinatal mortality and neonatal mortality rates in Malaysia during the years following the launch of the NRP programme.. The launch of the Malaysian NRP was associated with further improvement in perinatal and neonatal mortality rates.

Topics: Asphyxia Neonatorum; Cardiopulmonary Resuscitation; Competency-Based Education; Female; Humans; Infant, Newborn; Inservice Training; Intensive Care Units, Neonatal; Intensive Care, Neonatal; Malaysia; Male; Medical Staff, Hospital; Neonatal Nursing; Neonatology; Outcome Assessment, Health Care; Resuscitation

This prospective study aimed to compare serum creatine kinase MB isoenzyme (CK-MB) mass concentrations and cardiac troponin T (cTnT) concentrations during the first 48 h of life in asphyxiated term infants.. Serum cTnT and CK-MB mass concentrations of 50 term infants with clinical features of perinatal asphyxia were measured at birth and at 12, 24 and 48 h of age by chemiluminescence immunoassay. These infants were followed up until discharge or death. Cord blood CK-MB and cTnT concentrations of 50 healthy term infants were also assayed.. At birth, asphyxiated infants had significantly higher concentrations of cTnT and CK-MB than controls (P < 0.0001). Serum cTnT of asphyxiated infants with low ejection fraction <60% was significantly higher at 12 and 24 h than those with normal ejection fraction (P < 0.05). Asphyxiated infants with congestive cardiac failure had significantly higher serum cTnT concentration during the first 48 h of life than those without congestive cardiac failure (P or= 0.1).. Unlike CK-MB, serum cTnT concentrations are significantly higher in asphyxiated infants who die or develop cardiac dysfunction.

Topics: Asphyxia Neonatorum; Creatine Kinase; Creatine Kinase, MB Form; Female; Humans; Infant, Newborn; Isoenzymes; Malaysia; Male; Prospective Studies; Troponin T

A 2-month prospective study was carried out in a Kuala Lumpur maternity hospital to determine the antenatal and intrapartum factors associated with perinatal asphyxia in the Malaysian neonates. The incidence of perinatal asphyxia was 18.7 per 1000 livebirths. Of the 75 asphyxiated neonates born during this period, 70 (93.3 per cent) were of term or post-term gestation. The incidence of perinatal asphyxia was more common in the neonates with one of the following characteristics: low birth weight (< 2500 g), breech delivery, or delivery by instrumentation or lower segment Caesarean section (P < 0.001). Conditional logistic regression analysis of the asphyxiated and the control neonates in a nested case-control study (after controlling for sex, race, birth weight, modes of delivery, and maternal gravida) showed that there were two associated factors which were of statistical significance. These were: small-for-gestation neonates and the presence of intrapartum problems. Our study suggests that to reduce the incidence of perinatal asphyxia, the common causes of small-for-gestation neonates and the common types of intrapartum problems should be identified to enable appropriate preventive measures to be carried out.

Topics: Asphyxia Neonatorum; Birth Weight; Case-Control Studies; Delivery, Obstetric; Female; Humans; Incidence; Infant, Newborn; Infant, Small for Gestational Age; Malaysia; Pregnancy; Pregnancy Complications; Prospective Studies; Risk Factors