Neonatal disease severity scoring systems are needed to make standardized comparison between performances of different units and to give prognostic information to parents of individual babies admitted. Existing scoring systems are unsuitable for resource-limited settings which lack investigations like pH, pO2/FiO2 ratio, and base excess. This study was planned to evaluate Modified Sick Neonatal Score (MSNS), a novel neonatal disease severity score designed for resource-constrained settings. It was a facility-based cross-sectional analytical study, conducted in the “Special Newborn Care Unit” (SNCU) of government district hospital, attached to Kasturba Medical College, Mangalore, India from November 2016 to October 2017. A convenience sample of 585 neonates was included. Disease severity was assessed immediately at admission using MSNS. MSNS had 8 parameters with 0, 1, and 2 scores for each. 41% of study population was preterm (n=240), and 84.1% had birth weight less than 2500 grams (n=492). The mean (SD) of the total MSNS scores for neonates who expired and discharged was, respectively, 8.22 (2.96) and 13.4 (2.14), a difference being statistically significant at P<0.001. Expired newborns had statistically significant frequency of lower scores across each of the parameters. An optimum cutoff score of ≤10 with 80% sensitivity and 88.8% specificity in predicting mortality was obtained when the ROC curve was generated with the MSNS score as the test variable. Area under the curve was 0.913 (95% CI: 0.879–0.946). In conclusion, MSNS is a practicable disease severity score in resource-restricted settings like district SNCUs. It is for application in both term and preterm neonates. Total score ≤10 has a good sensitivity and specificity in predicting mortality of admitted neonates when used early during the course of hospitalization. MSNS could be used as a tool to compare performance of SNCUs and also enable early referral of individual cases to units with better facilities.

Background: Chronic job stress adversely impacts both mental health of nurses and patient care. There is paucity of data regarding workplace stressors and negative emotions among nurses. Aims: To assess depression, anxiety and stress among nurses and analyse their association with workplace stressors. Settings and Design: A hospital based cross-sectional study was conducted in two tertiary care hospitals. Methods and Material: Four hundred and thirty one nurses completed nurses rated depression, Anxiety and Stress instrument (DASS-21) and a questionnaire probing perceived workplace stressors on a 4 point Likert scale . The stressors across subgroups of workareas were compared. Satistical Analysis: Association between stress, anxiety or depression and workplace stressors were analysed using binary logistic regression. Results: 50.8% of nurses had stress; 74% had anxiety; 70.8% had depression. 79.1% had at least one of them. Stressed, anxious or depressed nurses were more concerned about lack of job satisfaction and conflicts with supervisors. Work-place stressors varied with work areas: private hospital, no job satisfaction, conflicts with doctors and patients; government hospital, acquiring infectious diseases; ICUs, inadequate salary; non-ICUs, odour and sounds in workplace and conflicts with patients. Conclusions: Prevalence of depression, anxiety and stress was high. Workplace stressors varied across different working areas. Interventions need are to be tailored accordingly.

Background: Cardiovascular disease is a common cause of death in developed countries and also is a rising trend in developing countries. Aim: The objective of this study was to compare lipid profile and atherogenic indices in term and preterm neonates. Methods: A total of 60 neonates were selected which were grouped on the basis of gestational age and birth weight. Umbilical venous blood was collected from them. Lipid profile (total cholesterol, LDL cholesterol, HDL cholesterol, VLDL cholesterol, triglycerides), apolipoproteins (apo B and apo A-I) and atherogenic index were evaluated and compared. Student-t test (unpaired) was applied to test the significance. Results: Mean serum cholesterol and LDL was significantly high in preterm .Mean TC / LDL ratio of preterm group 3.17, term 2.64 (p< 0.006).Mean Apolipoprotein A-1 in preterm 78.37 mg/dl, term 76.51 mg/dl (P<0.67). Mean apolipoprotein B / A-1 ratio in preterm 0.45, term 0.39, (p<0.11) showing worse profile in preterm. Conclusions: These findings demonstrate a trend towards worse lipid profile in preterm SGA new-borns. There is a need to investigate if this atherogenic lipid profile is a marker for future cardiovascular diseases.

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