Rajesh Maheshwari

Evaluation of standardized versus individualized total parenteral nutrition regime for neonates less than 33 weeks gestation.

Objective:  To evaluate the difference in nutrient intakes and biochemical responses in newborn infants <33 weeks gestation who received standardized versus individualized total parenteral nutrition (TPN) regimes.

Neopuff T-piece mask resuscitator: is mask leak related to watching the pressure dial?

Abstract Aim:  The aim of the study is to compare mask leak and delivered ventilation during Neopuff (NP) mask ventilation in two modes: (i) with NP pressure dial hidden and resuscitator watching chest wall (CW) rise with, (ii) CW movement hidden and resuscitator watching NP pressure dial.

Neonatal endotracheal intubation: How to make it more baby friendly.

Neonatal endotracheal intubation is commonly accompanied by significant disturbances in physiological parameters. The procedure is often poorly tolerated, and multiple attempts are commonly required before the airway is secured. Adverse physiological effects include hypoxemia, bradycardia, hypertension, elevation in intracranial pressure and possibly increase in pulmonary vascular resistance. Use of premedications to facilitate intubation has been shown to reduce but not eliminate these effects. Other important preventative factors include adequate training of the operators and guidelines to limit the duration of attempts. Pre‐intubation stabilisation with optimal bag and mask ventilation should allow for better neonatal tolerance of the procedure. Recent research has described significant mask leak and airway obstruction compromising efficacy of neonatal mask ventilation. Further research should help in elucidating mask ventilation techniques which minimise mask leak and airway obstruction.

Neopuff T-piece resuscitator mask ventilation: Does mask leak vary with different peak inspiratory pressures in a manikin model?

The aim of this study was to compare mask leak with three different peak inspiratory pressure (PIP) settings during T‐piece resuscitator (TPR; Neopuff) mask ventilation on a neonatal manikin model.

A Retrospective Study of Therapeutic Hypothermia in Neonatal Hypoxic Ischemic Encephalopathy

Abstract Objectives: Therapeutic hypothermia (TH) is now standard treatment for moderate to severe hypoxic ischemic encephalopathy (HIE), secondary to intrapartum hypoxia, and has been performed in our neonatal unit since 2008. Objectives of this study included the assessment of compliance with the TH protocol and the evaluation of 2-year outcomes. Materials and Methods: Medical records of all the infants who underwent TH (2008-2014) were reviewed and relevant data were extracted. The laboratory database was used to extract blood test results. Follow-up clinic records were reviewed to gather data for 2-year outcomes. Outcome at 2 years was dichotomized as normal (survival with no or mild impairment) and abnormal (death or survival with moderate or severe impairment). Regression analysis was performed to determine the association of perinatal variables with an abnormal outcome. Results: Seventy-seven infants were treated with TH with 40/77 (52%) cooled as per the protocol. Treatment with TH for stage 1 HIE was the most common reason for protocol noncompliance. A total of 71 infants had HIE (n = 26, 24, and 21 with modified Sarnat stages 1, 2, and 3 respectively). Sixteen infants with HIE (22.5%) died; all had stage 3 HIE. Forty-one infants were seen at ≥2 years. Of these, 34 infants (83%) had a normal outcome. The clinical stage of HIE was the strongest predictor of an abnormal outcome. Normal 2-year outcome was seen in 94%, 84%, and 5% of stages 1, 2, and 3 HIE respectively. Conclusions: We noted a high degree of variation from the TH protocol. Clinical staging of HIE remains the strongest predictor of long-term outcome.

Intravenous Lipids in Neonates

Postnatal growth restriction remains a major issue in high risk preterm neonates and term surgical neonates. Compared to other fields of medicine, development of intravenous lipid emulsion (LE) is quite recent. The first stable LE was introduced in 1960s. Currently typical soybean oil based LE remains the most commonly used intravenous LE in neonatal units. However there are still concerns about the adverse effects of soybean oil LE on immune system, liver metabolism and pulmonary physiology. The risk of infections may also be higher. Newer intravenous LEs are developed from various sources including olive oil, fish oil and combinations of various oils. Although, the newer LEs have potential short-term benefits with regards to laboratory markers such as peroxidation and cytokines as compared to typical soybean oil based LE, there is a lack of data on clinical outcomes and long term effects. This chapter reviews the history and chemistry of and the current evidence for typical soybean oil based LEs. The newer LEs and the data supporting their use in preterm and term neonates are also reviewed.

Stitch in time: Life‐saving thoracotomy for treatment of neonatal haemothorax

Pneumothorax is not uncommon in sick ventilated neonates particularly with meconium aspiration syndrome (MAS) or respiratory distress syndrome (RDS). Tension or clinically significant pneumothoraces are treated with intercostal drain (ICD) insertion. Haemothorax is an uncommon complication of ICD insertion though the incidence of the complication may be greater than is generally appreciated. Most cases are recognised retrospectively at autopsy. We report an intact survival in a patient with haemothorax as a result of laceration of the intercostal artery.