Day 1 :
Nassau University Medical Center, USA
Keynote: Early postnatal weight loss in extremely low birth weight infants (ELBW): Clinical determinants and implications in neonatal morbidities
Time : 08:45-09:45
We investigated early postnatal weight changes (EPWC) and their clinical implications in morbidities related to fluid metabolism in ELBW infants. As maximum weight loss (MWL) and daily body weight changes from birth weight (D∆ bw) during the ﬁrst 15 days of life, The mothers’ and infants’ demographic and clinical variables relevant to body fluid balance were correlated with MWL and D∆ bw via Pearson's correlation coefficient and Pearson's partial correlation tests. We further assessed effects of MWL graded as low (5-12%) moderate (18.1-12%) and high (18-25%) on these variables. MWL in the cohort (n=102) was 14.2+5.4%. MWL correlated negatively with GA, ANS and pregnancy-associated hypertension (PAH), and positively with BPD28, total days on oxygen, fluid intake, urinary output and the day of life when birth weight was surpassed. All these correlations were lost after controlling for GA except for the day of life when birth weight was surpassed. D∆ bw correlated inversely with GA and was associated with lower risks for BPD28, PDA, and IVH, which persisted after controlling for GA. ANS decreased the volume of D∆ bw. Maternal diabetes mellitus (GDM) and PAH were not noted in mothers in high MWL group, whereas 38% of mothers in low MWL group suffered from the latter.
Conclusion: MWL, governed by maturation, does not promote morbidities within the range of 14.5+4.2% of birth weight. D∆ bw is protective for PDA, BPD, and IVH. ANS, PAH and GDM decrease early postnatal weight losses in ELBW neonates.
David Strider has practiced at the University of Virginia Medical Center as a nurse for 35 years. He obtained his B.S. in Biology from the College of William and Mary and his MSN and Doctors in Nursing Practice from the University of Virginia. He is the president of PROSAMI.
Over the last year PROSAMI, a volunteer organization supporting maternal and infant care in the Democratic Republic of the Congo (DRC) , completed the education for nineteen (19) Congolese nurses, providing them with skills and cognitive resources to function as advanced nurse midwives . PROSAMI has been striving since May, 2009, to develop an educational program that could empower DRC nurses to be trained as advanced practice nurse midwives (ANM), with the expectation that such highly qualified health care practitioners can oversee the prenatal, delivery, and postnatal care of women in rural DRC areas.
Telemedicine support has facilitated the transmission of “cutting edge,” concise maternal / infant health care lectures to the ANM students. Each of the ANM students has received a laptop computer, a copy of the two - volume Sellers manual on nurse midwifery , and an obstetrical kit containing adult stethoscope and blood pressure cuff, fetoscope, scissors, umbilical clamps, and gauze. On March 10th, 2018, PROSAMI finalized the rental of a 1600 square feet stone building that will accommodate the education for and examination of young women prenatally, the space for normal deliveries , and a suite for post partum care of women and infants.
PROSAMI has utilized the Cascade teaching model within the Congo to begin reducing the previous infant mortality rate of 120 /1,000 live births in rural areas, along with the tragically high maternal mortality rate of 693 / 100,000 live births. The Pilot Center will offer comprehensive maternal and infant care services for a three mile radius. Midwives’ clinical services will be provided within a sliding scale matrix that is based on the household gross income. PROSAMI services are blossoming like a beautiful Congolese flower, and the PROSAMI health care model will benefit mothers and babies for many decades.