Deepak Louis

Longitudinal growth of very low birth weight neonates during first year of life and risk factors for malnutrition in a developing country

To study growth of very low birth weight neonates (VLBW) during first year and identify risk factors for malnutrition.

Predictors of mortality and major morbidities in extremely low birth weight neonates

ObjectivesTo determine predictors of mortality and morbidity in extremely low birth weight neonates (ELBW) from a developing countryStudy designProspective observational study.SettingLevel III neonatal unit in Northern India.SubjectsNeonates <1000g born and admitted to intensive care during study period were enrolled. They were analyzed based on survival and development of major morbidity. Multivariable logistic regression model was used to determine independent risk factors.OutcomeMortality and major morbidity (one or more of the following: Bronchopulmonary dysplasia (BPD), Retinopathy of Prematurity (ROP) requiring laser, grade III or IV intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL) and necrotizing enterocolitis (NEC) stage III) during hospital stay.ResultsOf 255 ELBW neonates born, 149 received optimal care, of which 78 (52%) survived and 57 (39%) developed morbidities. Mean birth weight and gestational age were 29.1±2.6 weeks and 843±108g. Major causes of mortality were sepsis (46%), birth asphyxia (20%) and pulmonary hemorrhage (19%). Birth weight ≤800g [OR (95% CI)-3.51 (1.39–8.89), P=0.008], mechanical ventilation [4.10 (1.64–10.28), P=0.003] and hypotensive shock [10.75 (4.00–28.89), P<0.001] predicted mortality while birth weight ≤800g [3.75 (1.47–9.50), P=0.006], lack of antenatal steroids [2.62 (1.00–6.69), P=0.048), asphyxia [4.11 (1.45–11.69), P=0.008], ventilation [4.38 (1.29–14.79), P=0.017] and duration of oxygen therapy [0.004 (1.001–1.006), P=0.002] were the predictors of major morbidities.ConclusionsLow birth weight, mechanical ventilation and hypotensive shock predicted mortality in ELBW neonates while low birth weight, lack of antenatal steroids, birth asphyxia, ventilation and duration of oxygen therapy were predictors for major morbidity.

Pulse Oximeter Sensor Application During Neonatal Resuscitation: A Randomized Controlled Trial

OBJECTIVE: This study was done to compare 2 techniques of pulse oximeter sensor application during neonatal resuscitation for faster signal detection. METHODS: Sensor to infant first (STIF) and then to oximeter was compared with sensor to oximeter first (STOF) and then to infant in ≥28 weeks gestations. The primary outcome was time from completion of sensor application to reliable signal, defined as stable display of heart rate and saturation. Time from birth to sensor application, time taken for sensor application, time from birth to reliable signal, and need to reapply sensor were secondary outcomes. An intention-to-treat analysis was done, and subgroup analysis was done for gestation and need for resuscitation. RESULTS: One hundred fifty neonates were randomized with 75 to each technique. The median (IQR) time from sensor application to detection of reliable signal was longer in STIF group compared with STOF group (16 [15–17] vs. 10 [6–18] seconds; P <0.001). Time taken for application of sensor was longer with STIF technique than with STOF technique (12 [10–16] vs. 11 [9–15] seconds; P = 0.04). Time from birth to reliable signal did not differ between the 2 methods (STIF: 61 [52–76] seconds; STOF: 58 [47–73] seconds [P = .09]). Time taken for signal acquisition was longer with STIF than with STOF in both subgroups. CONCLUSIONS: In the delivery room setting, the STOF method recognized saturation and heart rate faster than the STIF method. The time from birth to reliable signal was similar with the 2 methods.

Predictors of mortality in neonates with meconium aspiration syndrome

ObjectiveTo identify risk factors for mortality in neonates with meconium aspiration syndrome.MethodsAll neonates (2004–2010) with meconium aspiration syndrome, irrespective of gestation were included. Risk factors were compared between those who died and survived.ResultsOut of 172 included neonates, 44 (26%) died. Mean (SD) gestation and birth weight were 37.9 (2.3) weeks and 2545 (646g), respectively. Myocardial dysfunction [aOR 28.4; 95% CI (8.0–101); P<0.001] and higher initial oxygen requirement [aOR 1.04; 95% CI (1.02–1.07); P<0.001] increased odds of dying while a higher birth weight [aOR 0.998; 95% CI (0.997–1.00); P=0.005] reduced the odds of dying.ConclusionsMeconium aspiration syndrome is associated with significant mortality. Myocardial dysfunction, birth weight, and initial oxygen requirement are independent predictors of mortality.

Survival and morbidity among two cohorts of extremely low birth weight neonates from a tertiary hospital in Northern India

This study was conducted to compare the survival and morbidity of extremely low birth weight neonates born during two different time periods (2009–10 and 2001–02) at a Level III referral neonatal unit in Northern India. All consecutive intramural extremely low birth weight neonates (<1000g), irrespective of gestation, and admitted to Intensive Care were enrolled. 149 and 123 neonates were enrolled during 2009-10 and 2001-02, respectively. The baseline characteristics were comparable except for mean birth weight, which was lower during 2009-10 (843±108g vs 885±126g, P=0.003). Surfactant therapy (54% vs 18%, P<0.001), non-invasive ventilation (28% vs 6%, P<0.001), high frequency ventilation (24% vs 4%, P=0.001), IVH (52% vs 25%, P<0.001) and PDA (34% vs 18%, P=0.004) were significantly more during 2009–10. Culture positive sepsis (33% vs 51%, P=0.003) and ROP rates (7% vs 23%, P=0.042) were significantly higher during 2001–02. Overall survival was similar; however, neonates between 28–30 weeks gestation had better survival (63%) during 2009–10 compared to 2001–02 (38%), P=0.009. Survival in neonates 28–30 weeks improved during this period while overall survival remained the same.

Superior mesenteric artery Doppler is poor at predicting feed intolerance and NEC in preterm small for gestational age neonates.

Abstract Objective: To study SMA Doppler for predicting feed intolerance and necrotizing enterocolitis (NEC) in preterm SGA neonates with umbilical artery absent/reversed end diastolic flow (A/REDF). Study design: Prospective study. Patients: SGA neonates <36 weeks born with antenatally diagnosed A/REDF formed cases. Those with normal Doppler formed controls. Primary outcomes were feed intolerance and NEC. Peak systolic velocity, end diastolic velocity (EDV), time-averaged mean velocity, pulsatility index and resistive index (RI) were measured in SMA Doppler done postnatally on days 1 and 5. Results: Fifty neonates were enrolled in each group. Gestation, birth weight, gender and Apgar scores were comparable. Feed intolerance rate was similar (A/REDF: 26% versus controls: 20%, p 0.48), NEC was commoner in A/REDF group (32% versus 4%, p < 0.001). Baseline SMA Doppler indices were similar; RI on day 1 was higher in babies with A/REDF [5.4 (IQR 3.3, 7.3)] who developed NEC compared to controls [3.3 (IQR 1.7, 3.9)], (p 0.049). RI of 3.63 on day 1 had only a sensitivity of 61% and a specificity of 57% in predicting NEC in A/REDF group (area under curve (AUC) 0.61, 95% CI: 0.43–0.79, p = 0.25). Similarly, EDV of 8.7 cm/s had only a sensitivity of 61% and a specificity of 60% for the prediction of NEC (AUC of 0.64, 95% CI: 0.47–0.81, p = 0.16). Conclusions: Postnatal SMA Doppler indices do not predict feed intolerance and NEC in preterm SGA babies with A/REDF.

Longitudinal growth and post-discharge mortality and morbidity among extremely low birth weight neonates

ObjectivesTo study post-discharge growth, mortality and morbidity of extremely low birth weight neonates at corrected age of 2 years.MethodsWeight, length and head circumference were compared on WHO growth charts at corrected ages 3 (n=54), 6, 9, 12 (n=51) and 24 months (n=37); rates of underweight, stunting, microcephaly and wasting were calculated.ResultsThe mean Z-score for weight, length, head circumference and weightfor-length significantly improved from 3 to 24 months (P<0.001); a significant proportion remained malnourished at 2 years. Nine infants (11%) died and 35 (44%) required readmission during first year of age.ConclusionExtremely low birth weight neonates remain significantly growth retarded at corrected age of 2 years.

Isolated early onset anemia after rh isoimmunization: a unique presentation in 3 neonates.

Rh isoimmunization manifesting as isolated early onset neonatal anemia has not been reported. We describe the presentation of 3 infants who manifested with isolated early severe anemia. All the infants presented early (3 to 7 d of age) with severe pallor. None had clinically significant jaundice. Evidence for hemolysis was present in all and their direct antiglobulin test was positive. To reduce the hemolysis, immunoglobulin was administered after which their hemoglobin improved. This report highlights the possibility of early onset anemia without significant jaundice as the sole manifestation of Rh isoimmunization and the possible beneficial role of immunoglobulin in them.

An Unusual Case of Erb’s Palsy in a Neonate: A Case Report

Erb’s palsy occurs in neonates following traumatic delivery, where excessive traction on the neck stretches these nerve roots. Nonobstetric causes of Erb’s palsy are rare in neonates. The authors report the presentation of a female neonate with Erb’s palsy following a postero-lateral thoracotomy. The infant underwent surgery on day 3 of life for esophageal atresia and presented with right upper limb weakness on day 21 of life. She demonstrated features of Erb’s palsy with normal higher mental functions. An electromyography and nerve conduction study confirmed Erb’s palsy. The surgical procedure in the index case did not involve the brachial plexus. However, her right upper limb was positioned hyperabducted during the intraoperative period, which possibly had led to the palsy. The key message of this report is that prolonged stretching of the brachial plexus roots during surgery of the neck and thorax can be an important nonobstetric cause of Erb’s palsy in neonates

Multiple brain abscesses and facial palsy in a neonate

A term, 3.5-kg male neonate was referred to our hospital on day 5 of life for respiratory distress, hypoglycaemia and feed intolerance. There was no history of perinatal asphyxia or birth trauma. Investigations revealed thrombocytopaenia and coagulopathy with raised C reactive protein and leucocytosis. Chest x-ray was suggestive of pneumonia. …