BACKGROUNDPhysical, mental and gross motor development occur intensively during the childhood. Therefore it is important to detect any developmental delays early in order to take proper intervention which is significant for mental ability and personal development of a child. In this study, we aimed to evaluate mental and gross motor development of the kindergarten’s children in Bayanzurkh and Khan-Uul district.METHODSWe selected 157 children, aged from 3 to 6 years, from Bayanzurh district’s kindergarten and 125 children from Khan-Uul district’s kindergarten randomly. Population basedcross sectional study design was used. Mental and gross motor development was measured by Denver-II test. Statistical analysis of the collected data was conducted using SPSS 17.0 software program.RESULTSLanguage development delay, fine motor-adaptive development delay, gross motor development delay and personal-social development delay were observed in 42%, 15%, 12%, 8% of the kindergarten children, respectively.CONCLUSIONSWe conclude that it is imperative to pay more attention to mental, language and gross motor developments of children in kindergarten.

BACKGROUND: One of the confronted problems of health branch of Mongolia is to confirm pregnancy and delivery to health of mother and baby and to decrease early neonatal mortality and stillbirth. Rate of perinatal mortality becomes real index of health and quality of health care. In the world more than 6 million perinatal mortality and 2.6 million stillbirths occur in 1000 birth every year. In Mongolia last year’s birth increases and perinatal mortality hasn’t been decreased yet. By 2013 perinatal mortality of country and aimag 14.4 per 1000 birth, in eastern and khangai and central regions and Ulaanbaatar (UB) city it is fewer than the above mentioned average, but the western region it is 17.5 or 3.1 î/îî higher than average rate. GOAL: To study current situation of perinatal mortality in western region of Mongolia MATERIAL AND METHODS: On the base of statistical dates of perinatal mortality of Health indicators and dates of health authorities of western region of Mongolia in 2004-2013 we considered indications of stillbirth from 22 weeks of gestation and early neonatal mortality by trend criteria. RESULTS: In the period of last 10 years in the western region of Mongolia totally 94810 mothers gave a birth, perinatal mortality is 2347 or 24.7 per 1000 birth. 57.7% of total perinatal mortality is stillbirth and 42.3% is early neonatal mortality. Among 5 aimags of region in Bayn-Ulgii stillbirth is the highest (77.2%), in Gobi-Altai aimag early neonatal mortality is the highest (70.3%). Dates show that perinatal mortality rate is different among western region’s aimags. Trends of Mongolian western region’s perinatal mortality rate till 2016 years will increase in Zavkhan aimag by 8.6, and in Khovd aimag by 0.9; and in other aimags will decrease. CONCLUSION: Although perinatal mortality decreases in western region of Mongolia, it is always higher than average rate of country. Therefore it is necessary to improve quality of antenatal and prenatal care. By doing this trend of increasing and decreasing will become stable and further it will be decreased.

Glucose-6-phosphatase dehydrogenase (G6PD) deficiency is the most common enzyme deficiency in humans, affecting 400 million people worldwide and a high prevalence in persons of African, Middle Asian countries. The most common clinical manifestations are neonatal jaundice and acute hemolytic anemia, which is caused by the impairment of erythrocyte’s ability to remove harmful oxidative stress triggered by exogenous agents such as drugs, infection, or fava bean ingestion. Neonatal hyperbilirubinemia caused by glucose-6-phosphate dehydrogenase (G6PD) is strongly associated with mortality and long-term neurodevelopmental impairment. Aim:To determine a level of glucose-6-phosphate dehydrogenase in healthy neonates.The 76.5% of all participants (n=205) was assessed 4.36±1.15 Ug/Hb in normal reference range of G6PD other 23.5% (n=63) was 0.96±0.51 Ug/Hb with G6PD deficiency. In the both sex, 51.5% of male 0.88±0.46Ug/Hb (n=33) and 47.6%of female (n=30) 0.97±0.55Ug/Hb was assessed with G6PDdeficiency. Developing Jaundice period in number of 63 neonates with G6PD deficiency, 85.7% of neonates (n=54)was in 24-72 hours, 4% of neonates (n=3) was in 5-7 days and there is no sign of jaundice in 9% (n=6).Therefore neonates with G6PD deficiency, 53.9% (n=34)contiuned jaundice more than two weeks.G6PD deficiency was determined in male neonates (51.5%) more than female(47.6%). The 76.5% of all participants (n=205) was assessed 4.36±1.15 Ug/Hb in normal reference range of G6PD other 23.5% (n=63) of all participants was 0.96±0.51 Ug/Hb with G6PD deficiency. It shows that G6PD might be one potential risk of neonatal jaundice and hyperbilirubinemia in neonates in Mongolia.

JUSTIFICATION: According to the World Health Organization (WHO), 6.6 million children under the age of five died in 2012 - more than 750 every hour. Most of these children could survive and thrive with access to simple, affordable interventions. The loss of a child is a tragedy - families suffer and human potential is wasted. WHO is improving child health by helping countries deliver integrated, effective care in a continuum, starting with a healthy pregnancy for the mother, through birth and care up to five years of age. Investing in health systems is important to delivering this essential care [1, 2]. GOAL: To study perinatal mortality, this is the most important reason of infant mortality in Mongolia. MATERIALS AND METHODS: A retrospective cohort study was conducted reviewing data from 2007-2011 using the ICD code P00-P96 [4] listing “certain conditions originating in the perinatal period”. Data was analyzed using Epi-Info 2000 and GIS software. RESULTS: Data from 2007-2011 showed that 3091 neonates died from conditions originating in the perinatal period and of these 58.7% (1814) were males. Furthermore, the results of this study showed that the leading causes of death were “respiratory and cardiovascular disorders during the perinatal period” (ICD code P20-P29). More specifically, the causes were: - Birth asphyxia (P21) - Respiratory distress of newborn (P22) - Congenital pneumonia (P23) CONCLUSION: National average deaths per 1,000 live births in Mongolia are 9.5—with the highest rates reported in Dornogovi, Uvurkhangai, Bayankhongor, Gobi Altai, Uvs, Zavkhan and Khovsgol.

Bacterial infection continues to be the major cause of morbidity and mortality in the newborn of the developing countries. In Mongolia, 46% of deaths in neonates were due to sepsis in the period of 2004-2007. In Ulaanbaatar city 49.3% of late neonatal deaths were due to sepsis. Because the prognosis for sepsis largely depends on early identification and treatment, these neonates are subjected to extensive diagnostic evaluation and empirical systemic antibiotic treatment, pending laboratory results. Neonatal Sepsis is most likely to be caused by group B streptococci in developed countries and E. coli, Klebsiella sp. and Enterobacter sp. in developing countries. Methods. The present prospective study was performed in the neonatology unit of a tertiary-care Maternal and Child Health Resear Center after obtaining approval from the institutional ethics committee. Ninety seven neonates, ranging from birth to 30 days old, at risk of bacterial infection were evaluated. Risk factors were based on abnormal feto-maternal clinical findings, as described in standard textbooks of neonatology. One hundred and fifty two neonates with absence of feto-maternal risk factors were included in the present study as controls. This was to highlight the basic difference in the values of haematological parameters between neonates clinically suspected of infection and those who were without any risk factors. An extensive perinatal history, as well as a complete record of clinical signs and laboratory data, were recorded in each case. Blood samples were obtained from peripheral venipuncture in all neonates within 24 h of admission, before initiation of antibiotic therapy. Conclusions: 1. Most common risk factors of neonatal sepsis are maternal bacterial vaginosis (OR=5.7), kidney disease during pregnancy (OR=2.4), gestosis of pregnant women (OR=3.2), maternal infectious disease (OR=2.3), and anemia (OR=1.6). 2. Enterobacteriaceae was the most common organism isolated (55%), followed by Escherischia coli, and Klebsiella. 3. Among 73% of neonatest the clinical signs of sepsis were identified during the early neonatal period, 62% of them during the first 3 days of life. The common clinical type of neonatal sepsis was hypoergetic. 4. 60% of neonates were preterm and 44% were LBWI. 5. The haematological findings significantly associated with sepsis and their comparison with the values recommended. 6. A haematological score can be obtained by a complete blood count and examination of peripheral blood smear, thus permitting an objective assessment of haematological changes that occur in a neonate suspected of sepsis.

Congenital heart disease (CHD) is one of the most common birth defects, with an incidence of nine out of every 1,000 live births. Critical CHD (CCHD) is defined as cardiac lesions that require surgery or cardiac catheterization within the first month (or within the first year by different definitions) of life to prevent death or severe end-organ damage. An early diagnosis and timely intervention can significantly reduce the likelihood of an adverse outcome. However, studies from the United States and other developed countries have shown that as many as 30%–50% of infants with CCHD are discharged after birth without being identified. Pulse oximetry is a tool to measure oxygen saturation, and based on the presence of hypoxemia, many cardiac lesions are detected. Due to its ease of application to the patient, providing results in a timely manner and without the need for calibrating the sensor probe, pulse oximetry offers many advantages as a screening tool. Pulse oximetry was recommended as a screening tool to detect critical CHD in 2011 by the American Academy of Pediatrics and the American Heart Association. Pulse oxymetry screening (POS) for early detection of CCHD is a simple, noninvasive, and inexpensive test, which meets the necessary criteria for inclusion to universal newborn screening panel. Wider acceptance and adoption can significantly decrease morbidity and mortality in infants with CCHD.

Background: Pneumonia is one of the leading causes of morbidity and mortality in children around the world. Annually, it’s estimated about total of 120 million cases of pneumonia occur in children under the age of five around the world and about 2 million of them end in mortality. In 2017, respiratory diseases constituted 31.3% of all diseases in children under the age of five in Ulaanbaatar city. 268 cases of respiratory diseases occur in every 1000 children, making it the leading disease in children of that age group. Sonographic examination has several advantages including lack of radiation, accessibility, portable (can easily bring it next to the patient’s bed), cost effective, and can be used repeatedly on the patients. To our knowledge, currently in Mongolia, there are no published research materials on sonographic examination in children with pneumonia. Given, the lack of study, increased rate of pneumonia and advantages of ultrasonographic, the present study was performed to detect lung ultrasound sign of pneumonia and determine the specificity and sensitivity of lung ultrasound and X-ray. Methods: The study used cross-sectional studies of analytical study. 379 inpatient children aged between 1 month to 14 years old who are in the children’s hospital of Bayangol district between 1st of September 2019 to 1st of December 2019 participated in the study. Procedures included collection of questionnaires from the parents or the guardians, random collection of data from the patients’ history, and assessment of results from ultrasound and X-ray examination. The study used Stata software to analyze the statistics. Results: 56% or 210 cases showed decreased echogenicity in the ultrasound examination. Incorporated B line sign (р=0.001),, decreased echogenicity in the consolidation (р=0.001), and presence air positive bronchus (р=0.001), are shown to the major sign of pneumonia in ultrasound examination. Conclusions In pneumonia, following signs are present in lung ultrasound: Unilateral B-lines, consolidation, hypoechoic, irregular shaped consolidation, positive air bronchogramm sign in lung. From the results of our research, we discovered diagnosis sensitivity of pneumonia in ultrasound is 85%, specificity of pneumonia in ultrasound is 87%, sensitivity of pneumonia in Х ray is 78%, specificity of pneumonia in Х ray is 84%.