Manoj Modi

Growth and neurodevelopmental outcome of VLBW infants at 1 year corrected age

ObjectivesTo evaluate growth and neurodevelopmental outcome of very low birth weight infants (VLBW) and compare with term normal birth weight infants (NBW) till 12 months corrected age.DesignA prospective cohort studySettingTertiary care neonatal unit in northern IndiaSubjects37 VLBW infants and 35 NBW infants born between January 2007 and December 2007.InterventionsAnthropometric measurements were recorded and Z-scores were computed serially at birth, discharge, 40 weeks post menstrual age (PMA), and at 1, 3, 6 and 12 months of corrected age. Developmental quotient (DQ) at 12 months corrected age was assessed.ResultsZ-scores for weight, length and head circumference (HC) at birth were −1.21(±0.92), −0.98(±1.32) and −0.70(±1.14), respectively for VLBW infants and −0.37(±0.72), −0.11(±0.96) and 0.05(±0.73) respectively for NBW infants. VLBW infants had a significant drop in all Z-scores by discharge (P<0.001). There was a catch up to birth scores by 12 month age. VLBW infants had significantly lower Z-scores for weight, length and HC at one year corrected age as compared to NBW infants (P =0.01, 0.04 and 0.001, respectively). DQ at 12 months was significantly lower in VLBW infants (91.5+7.8) than NBW infants (97.5±5.3) (P <0.001). DQ of small for gestational age (SGA) and appropriate for gestational age (AGA) VLBW infants was comparable.ConclusionVLBW infants falter in their growth during NICU stay with a catch-up later during infancy. In comparison to NBW infants, they continue to lag in their physical growth and neurodevelopment at 1 year of corrected age.

50 years of neonatology in India, progress and future.

India has made impressive gains in its child survival indices during the past half a century with infant mortality rates declining from 159.3 in 1960 to 44 in 2011 and neonatal mortality rate declining from 47 (1990) to 32 (2010). Neonatal health is now an integral part of the country’s flagship program — National Rural Health Mission. Facility based newborn care is not only available in large public and private sectors hospitals, but also in about 300 of India’s district hospitals. Complementing these efforts is home based newborn care being delivered by community health volunteers. The last two decades has also witnessed an increase in newborn research and its incorporation into medical and paramedical education as a major course component. Neonatology now is an independent superspecialty in India. The National Neonatology Forum has had a major role in spearheading reforms in neonatal care in India.

T-piece or self inflating bag for positive pressure ventilation during delivery room resuscitation: An RCT

OBJECTIVE To compare the duration of positive pressure ventilation (PPV) during delivery room resuscitation in neonates resuscitated with self-inflating bag (SIB) and T-piece resuscitator (TPR). DESIGN Randomized control trial. SETTING Delivery room and neonatal intensive care unit of a tertiary care center in northern India. PATIENTS Consecutively born neonates more than 26 weeks of gestation requiring PPV at birth. INTERVENTION Eligible neonates were randomized to two groups, SIB and TPR. OUTCOME MEASURES Duration of PPV, intubation rates in delivery room, incidence of respiratory distress, need for mechanical ventilation during first 48h and its duration, need for surfactant replacement therapy and mortality during NICU stay. RESULTS Fifty neonates received PPV with a SIB and 40 received PPV with a TPR. The mean (SD) birth weight and gestational age of neonates in SIB and TPR groups were 2264 (872) and 2065 (814)g; 35.1 (3.6) and 34.3 (3.7) weeks, respectively. The median (IQR) duration of PPV in delivery room was significantly less in TPR group as compared to SIB; 30 (30-60)s vs. 60 (30-90)s, respectively; (p<0.001). A higher proportion of neonates required delivery room intubation in SIB group as compared to TPR group (34% vs. 15%, p=0.04). In the TPR group, a higher proportion of neonates could be resuscitated with room air only (72.5% vs. 38%, p=0.001). Other outcomes were comparable in the two groups. Similar findings were observed in neonates <34 weeks, except that fewer neonates resuscitated with TPR required invasive ventilation (31.6% vs. 77.8%, p=0.008). CONCLUSION Use of TPR during delivery room resuscitation resulted in shorter duration of PPV and lesser rates of intubation as compared to SIB. More infants in this group could be resuscitated with room air only (CTRI/2010/091/002946).

Abdominal circumference or gastric residual volume as measure of feed intolerance in VLBW infants.

Background: The aim of the study was to compare prefeed abdominal circumference (AC) and gastric residual volume (GRV) as a measure of feed intolerance in very-low-birth-weight infants (VLBW). Methods: Eighty VLBW infants were randomized to 2 groups; feed intolerance was monitored by measuring either GRV group or prefeed AC group. The primary outcome was time to full enteral feeds (180 mL · kg−1 · day−1). Other main outcome measures were feed interruption days, duration of parenteral nutrition, incidence of culture positive sepsis, necrotizing enterocolitis, mortality, and duration of hospital stay. Results: The median (interquartile range) time to achieve full feeds was 10 (9–13) versus 14 (12–17.5) days in AC and GRV groups, respectively (P < 0.001). Infants in AC group had fewer feed interruption days (0 [0–2] vs 2.0 [1, 5], P < 0.001) and shorter duration of parenteral nutrition (P < 0.001). The incidence of culture-positive sepsis in AC and GRV groups was 17.5% and 30 %, respectively (P = 0.18). Duration of hospital stay and mortality were comparable in both the groups. Conclusions: Prefeed AC as a measure of feed intolerance in VLBW infants may shorten the time taken to achieve full feeds.

Human Milk Fortification in India

Human milk fortification in preterm babies has become a standard of care in developed countries. Use of human milk fortifier (HMF) in very-low-birthweight infants is not a routine practice in India. There are concerns about high osmolality, feed intolerance, necrotizing enterocolitis, risk of contamination and added cost associated with use of HMF. There are limited data from India which address the issue of safety and short-term benefits of human milk fortification. This chapter highlights the issues related to human milk fortification in our country.

Fetal-neonatal iron deficiency is associated with poorer auditory recognition memory at 2 months of age

Commentary on: Geng F, Mai X, Zhan J, et al. Impact of fetal-neonatal iron deficiency on recognition memory at 2 months of age. J Pediatr 2015;167:1226–32.[OpenUrl][1][CrossRef][2][PubMed][3] Iron is vital for brain growth during fetal life and early childhood, as it supports neuronal and glial energy metabolism, neurotransmitter synthesis and myelination.1 The association of fetal-neonatal latent iron deficiency (LID) with abnormal neurocognition during early infancy has been evaluated by hippocampal event-related potentials (ERPs) for memory recognition and by auditory brainstem response (ABR) for auditory neuronal maturation.2 ,3 LID during infancy has also been associated with poor neurocognitive outcomes with impaired mental and psychomotor functions at school age.4 … [1]: {openurl}?query=rft.jtitle%253DJ%2BPediatr%26rft.volume%253D167%26rft.spage%253D1226%26rft_id%253Dinfo%253Adoi%252F10.1016%252Fj.jpeds.2015.08.035%26rft_id%253Dinfo%253Apmid%252F26382625%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/j.jpeds.2015.08.035&link_type=DOI [3]: /lookup/external-ref?access_num=26382625&link_type=MED&atom=%2Febmed%2F21%2F3%2F112.atom

Approach to neonatal hypoglycemia

Despite hypoglycemia being a common occurrence in neonates, there is lack of agreement on definition of hypoglycemia. Most usual definition of hypoglycemia is a blood sugar level below 40 mg/dl. However, importance of this cut off is unclear as values below 40mg/dlmay be observed in upto 10% of healthy asymptomatic neonates during first 24 h. Nevertheless, a value of 40 mg/dl is the usual threshold for intervention. Usually, blood glucose monitoring is done with glucometer on a drop of heal prick sample on reagent strip. Reagent strips measure whole blood glucose which is 15% lower than plasma levels. A low reading with glucometer, should be confirmed by laboratory plasma glucose determination, though intervention need not to be delayed, pending lab results.