Bhavani Sriram

Two‐year neurodevelopmental outcome in children conceived by intracytoplasmic sperm injection: prospective cohort study

Objective  Primary outcome was to compare neurodevelopmental outcome at two years in intracytoplasmic sperm injection (ICSI) conceived children versus matched controls. Secondary outcome was to determine incidence of major congenital malformations and study perinatal outcome.

Saline Enemas versus Glycerin Suppositories to Promote Enteral Feeding in Premature Infants: A Pilot Randomized Controlled Trial

Background: Meconium retention is associated with feeding intolerance. Trials using glycerol and Gastrografin to expedite the evacuation of meconium have failed to generate clinically valid results for efficacy and safety. Objective: We assessed the feasibility of aggressive meconium evacuation with saline rectal washout (RW) in very-low-birth-weight infants to reduce the time it took them to reach full enteral feeds. Methods: We conducted an open-label, pilot, randomized controlled trial (RCT) (birth weight stratified, i.e., to 750-999 g and 1,000-1,500 g) of early aggressive meconium evacuation with twice-daily normal saline RW compared to conventional management with glycerin suppositories (GS), until full enteral feeds (110 mL/kg/day) were reached. Primary outcome was time to reach full enteral feeds. Safety, process, and secondary efficacy outcomes were also evaluated. Results: Sixty-one infants were randomized, 28 to RW and 33 to GS. The process and feasibility outcomes were met. RW was found to be safe; none of the RW-randomized infants developed necrotizing enterocolitis (≥ stage II) or complications secondary to RW. Evidence of efficacy was supported: in the 750-999 g stratum (n = 15), the median time to full enteral feeds was shorter with RW (11.0 days, 95% CI: 10.4-11.6) than with GS (15.6 days, 95% CI: 13.0-18.2) by a reduction of 4.6 days (p = 0.027). In the 1,000-1,500 g stratum (n = 46), there was no evidence of benefit: RW 10.2 days (95% CI 8.3-12.1) and GS 10.1 days (95% CI 9.3-10.9, p = 0.304). Conclusion: Our protocol was feasible and an adequately powered RCT is required to confirm the findings of this trial.

Ex-utero Intrapartum Treatment (EXIT) Procedure for Giant Fetal Epignathus.

BackgroundLarge fetal oropharyngeal tumors are rare, and have the potential to cause airway obstruction during birth.Case characteristicsA 35-year-old woman with antenatally diagnosed large heterogenous mass in fetal neck displacing trachea and filling up the orophanygeal space.InterventionThe infant was delivered at 31 weeks of gestation by ex-utero intrapartum therapy procedure to secure the airway.OutcomeTumor was resected successfully on day 8 of life. Histopathology revealed mixed teratoma.MessageEx-utero intrapartum therapy for fetuses with severe upper airway compromise may prove life-saving.

Neonatal small left colon syndrome.

A female baby, second of a monochorionic diamniotic pregnancy was born at 34 weeks of gestation via vaginal delivery. Birth weight was 2400 g. During the antenatal period mother had gestational diabetes requiring insulin therapy. The baby was admitted to neonatal unit for continuous positive airway pressure support for respiratory distress, which had improved within 4 h. At around 24 h of life she was noted to have large amount of non-bilious gastric aspirates and abdominal distension. An …

Transcatheter Removal of Peripherally Inserted Central Catheter Adherent to the Ventricular Septum

We describe an unusual case of a young child with peripherally inserted central catheter (PICC) adherent to the ventricular septal wall 5 days following insertion. The impacted PICC was successfully retrieved using a transcatheter procedure. The technique describes the freeing of an intracardiac central line with closed ends.