National Collaborative Perinatal Neonatal Network (NCPNN)
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Research & Non-Research Projects / Completed Projects

1. Building a region network with WHO EMRO

2. The Study on Morbidity and Mortality Among Newborn Babies, Infants, and Under Five Year Old Children in Greater Beirut

3. Establishing a Neonatal Resuscitation Program in Lebanon (NRP)

4. Prenatal and Neonatal Group B Streptococcus Screening and Sero-typing in Lebanon: Incidence and Implications

5. Exploring the Potential Impact of Preconceptional Care Including Folic Acid Supplementation on Pregnancy Outcomes in Three Countries of the Middle East

6. Multi-Country Study on Maternal Complications and Near Misses – Funded By The World Health Organization

7. Improving Maternal and Neonatal Health in Lebanon: Funded by the University Research Board

8. Randomized controlled Trial - The effect of antenatal steroids for women at risk of late preterm delivery on neonatal respiratory morbidity: a Multicenter Pilot Study

9. Effects of the medical environment (practice location) and clinical experience on the approach to the monitoring, workup and management of apnea of prematurity

10. The Epidemiology of Cytomegalovirus (CMV) in Beirut































Building a region network with WHO EMRO

Like other developing countries, the Eastern Mediterranean Region suffers from fragmented and incomplete data on maternal, perinatal and neonatal indicators. Limited resources and the lack of health care infrastructure and of continuous systems of assessment are enormous barriers faced by governments trying to implement collaborative systems. In this context, there is an urgent need for a collaborative effort to build a regional network for maternal and perinatal neonatal care, able to create scientific systems for accurate collection, analysis and interpretation of health data.

With the support of the WHO, MOD and other organizations, we are currently aiming at implementing our network model regionally by including new centers from the region such as Jordan, Abu Dhabi, Yemen, Syria and Saudi Arabia. Launching the regional network will take place during a workshop that will be held on November 21 and 22, 2008.

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Establishing a Neonatal Resuscitation Program in Lebanon (NRP)

Background:

It is reported that neonatal mortality accounts for 38% of all deaths in children less than 5 years. As over 19% of neonatal deaths worldwide are caused by birth asphyxia, improving the resuscitation skills of health attendants is an effective strategy for preventing a large proportion of neonatal death and for improving the outcomes of resuscitated newborns.

Objectives:

To establish the Neonatal Resuscitation Program (NRP) in Lebanon To train health care personnel in hospitals in Lebanon, urban and rural, in neonatal resuscitation To improve the knowledge and skills of trained health care personnel To decrease in-hospital neonatal mortality rates at health care institutions belonging to a perinatal neonatal research network in Lebanon.

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The Study on Morbidity and Mortality Among Newborn Babies, Infants, and Under Five Year Old Children in Greater Beirut

To date few, if any, cohort studies were conducted in Lebanon and the region to assess morbidities and outcomes in healthy infants less than one year of age.

Most Studies reviewed from the literature invariably included either at risk, sick newborns, or primary school children.

This follow up study by the NCPNN can be regarded as pioneering in being the first cohort study that involves a considerably large number of newborns (1,320) selected from the Greater Beirut area, Lebanon.

This study was done with the collaboration of 117 pediatricians from the same area.

The study encompassed more than one outcome measure and assesses their incidence rates.

Some of the studied outcomes include: vaccination and breastfeeding practices, morbidities, impact of early discharge, and others.

The overall objective of the study was to assess the causes of morbidity and mortality during the first five years of life in a developing country.

Results of the first year of life follow-up have been published (monograph) (PDF Format) and disseminated during the WorkShop that was held on February 20 and 21, 2004.

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Prenatal and Neonatal Group B Streptococcus Screening and Sero-typing in Lebanon: Incidence and Implications

Group B streptococci (GBS) infection is one of the leading causes of morbidity and mortality in newborns and is a main etiological factor for neonatal bacterial sepsis.

In Lebanon, there is a lack of uniform policy for GBS testing among pregnant women.

The National Collaborative Perinatal Neonatal Network (NCPNN) conducted a cross-sectional study between February 1, 2004, and September 30, 2004 enrolling 775 pregnant women admitted to the delivery suite of three major hospitals located in Beirut, namely the American University of Beirut Medical Center (AUBMC), Makassed General Hospital (MGH), and Hotel Dieu De France (HDF) and 682 newborns.

The objective of the current study was to determine the prevalence, risk factors, perinatal transmission to newborn infants, and serotype distribution among pregnant women and their newborns prior to the implementation of a universal ante partum GBS screening in Lebanon.

The results showed that pregnant women in Lebanon have a relatively high prevalence of GBS colonization (18%) and 7.3% for the newborns with no significant identifiable risk factors for its acquisition.

These results could provide basis for the institution of a national policy for universal screening of pregnant women to reduce neonatal morbidity and mortality.

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Exploring the Potential Impact of Preconceptional Care Including Folic Acid Supplementation on Pregnancy Outcomes in Three Countries of the Middle East

Exploring the Potential Impact of Preconceptional Care Including Folic Acid Supplementation on Pregnancy Outcomes in Three Countries of the Middle East.

Summary of the Study Done in Lebanon (by NCPNN) (PDF Format)

The objective of the study is to assess the prevalence and determinants of preconceptional folic acid supplement use among pregnant women in Lebanon.

Data analysis was performed on 5,280 deliveries admitted to twelve member hospitals of the National Collaborative Perinatal Neonatal Network NCPNN) during the period September 2003-January 2005.

Information on folic acid intake and maternal and neonatal characteristics were obtained from obstetric charts along with direct interviews performed by trained personnel.

Stepwise logistic regression was performed to determine predictors of preconceptional folic acid use.

The overall use of preconceptional folic acid supplementation was 14.0% (18.5% in urban hospitals vs. 2.7% in rural hospitals).

Higher socioeconomic status, older maternal age at current pregnancy, lower parity, and having a history of previous spontaneous abortions were significantly associated with preconceptional folic acid use.

This study showed that Lebanon currently has a low rate of preconceptional folic acid supplement use.

Intervention through the means of awareness campaigns needs to be implemented on a national level.

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MULTI-COUNTRY STUDY ON MATERNAL COMPLICATIONS AND NEAR MISSES – FUNDED BY THE WORLD HEALTH ORGANIZATION

In Lebanon, maternal health data is lacking due to the absence of a well-established national health statistical information system.

The rate of maternal mortality in Lebanon has varied across the years to reach 23 per 100,000 live births in 2010 according to the World Health Organization (WHO).

Since measuring maternal mortality seems to be a tedious task, WHO have developed a more frequent method to estimate maternal mortality by measuring severe maternal morbidities that could have led to maternal death in the absence of medical intervention.

This approach, known as “near miss”, describes women who experienced and survived a severe health condition during pregnancy, childbirth, or postpartum.

To the best of our knowledge, near miss cases have not been estimated yet in Lebanon or the region.

Therefore, the NCPNN conducted a study on maternal complications and near misses across some member hospitals in Lebanon and the East Mediterranean region in collaboration with the World Health Organization in Geneva.

This study is part of a bigger study conducted by WHO across 29 countries worldwide.
The NCPNN pilot study will include centers from Lebanon, Palestine, Jordan, and Qatar. Read More on MCS survey

Objectives:

a. To study the incidence of major maternal complications, maternal near miss, and preterm birth, their associated factors and outcomes.
b. To examine the relationship between the use of preventive and therapeutic interventions related with major maternal complications and the occurrence of maternal near miss and perinatal outcomes.
c. To examine the relationship between the use of preventive and therapeutic interventions related with preterm birth and the maternal and perinatal outcomes.

Participating Countries and Territories (PDF Format) (pdf format)
Participating Centers and Personel as part of NCPNN (PDF Format)

Interaction with Countrues and Information System Synchronization

The WHO MCS survey was placed on the NCPNN software where data from Jordan, Qatar, Palestine, and Lebanon was submitted and uploaded to the coordinating center at the American University of Beirut. Synchronization between the NCPNN software and the WHO software was performed to ensure the appropriate shipment of accurate data.

More information on MCS:

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Improving Maternal and Neonatal Health in Lebanon: Funded by the University Research Board

Funded by the University Research Board at the American University of Beirut, the NCPNN has performed secondary data analysis using the NCPNN database on three major topics: maternal morbidities, neonatal mortality and preterm birth.

Data Analysis aimed at studying:

  • The effect of consanguinity on preterm birth: manuscript published in the American Journal of Epidemiology.
  • The effect of consanguinity on neonatal mortality: manuscript ready to be submitted for publication.
  • The effect of gestational weight gain on the relationship between pre-pregnancy BMI in underweight women and their risk of preterm birth: manuscript is in progress.

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Randomized controlled Trial - The effect of antenatal steroids for women at risk of late preterm delivery on neonatal respiratory morbidity: a Multicenter Pilot Study

Newborns between 34 0/7 and 36 6/7 weeks of gestation referred to as late preterm babies are at higher risks than are term infants in developing respiratory problems and other complications.

It is the standard of care to administer antenatal steroids to women who deliver prior to 34 weeks of gestation.

However, there is no evidence yet concerning the effectiveness of the drug in women between 34 0/7 and 36 6/7 weeks of gestation.

The study aims at assessing the effectiveness of antenatal steroids during 34 0/7 and 36 6/7 weeks of gestation in decreasing respiratory complications and morbidity in late preterm babies.

This study is a double blind multicenter randomized controlled trial. 700 women at 34 0/7 - 36 6/7 weeks’ gestation and at high risk of preterm birth from five health centers in Lebanon will be randomly assigned to a single course of antenatal steroids or placebo (350 in each arm).

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Effects of the medical environment (practice location) and clinical experience on the approach to the monitoring, workup and management of apnea of prematurity

This study is conducted in collaboration with Case Medical Center, Rainbow Babies and Children’s Hospital, USA.

The study will be conducted in centers in four different countries, Case Medical Center, Rainbow Babies and Children’s Hospital – USA, The Royal Women's Hospital, Melbourne – Australia, Ramathibodi Hospital School of Medicine, Mahidol University – Thailand, and the 31 NCPNN member hospitals – Lebanon.

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The Epidemiology of Cytomegalovirus (CMV) in Beirut

Background:

In Lebanon and the region, data on the prevalence of CMV infection in pregnant woman and newborns as well as the health implications of the virus, especially hearing loss, is completely lacking. Epidemiologic estimations reveal that around 660 newborns are infected every year in Lebanon with CMV.

Objectives:

This study consists of two phases. The objectives of the first phase are to:

  • Determine the prevalence and risk factors of CMV infection among pregnant women at delivery
  • Determine the prevalence of congenital CMV infection among newborn infants at birth
  • Determine the rate of hearing impairment among CMV infected newborn infants at birth

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