Commentary: Current State of Home Health in Children with Medical Complexity
Current State of Home Health in Children with Medical Complexity, published in 2024, addressed several important aspects of barriers to care in children with medical complexity (CMC). This article specified three themes which were chosen due to their frequent appearances in the available research: lack of resources, financial implications, and patient and family well-being. This article serves as a commentary of the aforementioned article. Social risks and language barriers also pose a threat to success in home health, though the research in pediatrics is lacking. Reimbursement of nursing continues to be a theme, and the concept of state-to-state variances further affecting quality home health care is discussed. Health Policy is presented as an entirely new theme with a significant impact on home care delivery. An overall need for future research is paramount in this population as the number of CMC who need care in the home continues to grow due to health care improvements over time.
Caring for children with medical complexities (CMC) continues to be a difficult path for both healthcare providers and the caregivers of these children. Lack of resources, financial implications and patient and family well-being, the three themes discussed in Current State of Home Health in Children with Medical Complexity, have continued to evolve and change since its publication. Additionally, Health Policy has emerged as a theme in that it provides barriers to proper home care. As the healthcare landscape changes and grows, reflection on the changes within these roadblocks was paramount to remain up to date on the current issues. Though there is currently more research, it is worth highlighting that this area of healthcare is largely unexplored and in need of further discovery in order to start addressing this problem wholly.
DOI: 10.29245/2578-2940/2025/1.1179 View / Download PdfImmediate Newborn Outcomes of Early Neonates Born to Mothers Who Received Magnesium Sulphate During Intrapartum at Kawempe National Referral Hospital- Uganda.
Background: Magnesium sulphate (MgSO4) is a drug used to prevent and treat preeclampsia with severe features (PEC) and eclampsia in pregnant women. MgSO4 is also known to readily cross the placenta, fetal membranes and into the fetus and amniotic fluid and may produce hypotonia and hypotension. We set out to assess immediate newborn outcomes of early neonates born to mothers with preeclampsia receiving MgSO4 during intrapartum period.
Methods: This was an analytical observational cohort study at Kawempe National Referral Hospital in Uganda. Two hundred ten pregnant mothers with PEC or eclampsia were recruited in the study after receiving the loading dose of MgSO4 and then followed through labour and delivery to observe immediate newborn outcomes using Apgar score and the hospitalized newborns were followed through their first seven days of life and scored using Thompson scores. SPSS version 23 was used to analyse data to report frequencies, means and relationships between variables through chi square and analysis of variance (ANOVA) tests. P values <0.05 were considered statistically significant.
Results: The majority, 178/210 (84.8%), of the mothers delivered live babies, while 32/210 (15.2%) delivered stillbirths (13/32; 40.6% FSBs and 19/32; 59.4% MSBs). The mean (SD) Apgar score was 9.02 (1.45) with the majority 166/210 (93.3%) of the newborns having seven or higher. Factors significantly associated with the Apgar scores were maternal diagnosis (p<0.001) and NICU admissions (p<0.001). Apgar scores significantly differed by the gestational age (p<0.001), liquor state (p<0.001), labor induction (p<0.001) and birth weight (p<0.001). The mean (SD) Thompson score was 3.31 (±4.63) units. The majority 37/55 (67.3%) of the children had mild Hypoxic-Ischemic Encephalopathy (HIE) whereas 17/55 (30.9) were normal without HIE. Only one child had severe HIE. Thompson scores significantly differed by the mode of delivery (p<0.033).
Conclusions: The majority of NICU admissions were caused by respiratory issues and preterm deliveries. The significant number of newborns experiencing mild HIE puts these infants at risk for both immediate and long-term complications. Therefore, extreme care must be exercised when giving MgSO4 to mothers, as improper administration of the drug could further endanger the health and well-being of the newborns.
DOI: 10.29245/2578-2940/2025/1.1180 View / Download Pdf