Sunil Gothwal

Umbilical cord milking and hematological parameters in moderate to late preterm neonates: A randomized controlled trial

ObjectiveTo investigate the effect of umbilical cord milking on hematological parameters at 6 weeks of age in late preterm neonates.DesignRandomized controlled trial.SettingA tertiary care center of Northern India during 2013-14.Participants200 moderate to late preterm neonates randomly allocated to early cord clamping or umbilical cord milking group (100 in each).InterventionIn milking group, 25 cm length of cord was milked towards the baby thrice after separating (within 30 s) it from placenta.Main outcome measuresHemoglobin and serum ferritin at 6 weeks of age.ResultsMean (SD) serum ferritin [428.9 (217.6) vs. 237.5 (118.6) ng/mL; P< 0.01] and hemoglobin [12.1 (1.5) vs. 10.4 (1.2) gm/dL; P<0.01] at 6 weeks were significantly higher in umbilical cord milking group. In early neonatal period, hemodynamic and hematological parameters were not significantly different. Higher incidence of jaundice with higher phototherapy rates (33% vs. 9%; P<0.01) were noted in umbilical cord milking group.ConclusionIn preterm neonates, umbilical cord milking at birth enhances iron stores at 6 weeks of age. Higher phototherapy rates with this intervention are a matter of concern.

Comparison of Umbilical Cord Milking and Delayed Cord Clamping on Cerebral Blood Flow in Term Neonates

ObjectiveTo compare the effect of umbilical cord milking (UCM) and delayed cord clamping (DCC) on cerebral blood flow in term neonates.MethodsThis randomized controlled trial was conducted at a teaching hospital in India during 2012 to 2013. Two hundred newborns (>36wk) were randomized to UCM and DCC groups. UCM was done on 25cm of cord length. In DCC group, clamping was delayed by 60 to 90s. Resistive Index (RI), Pulsatility Index (PI) and cerebral blood flow velocities of middle cerebral artery (MCA) were measured at 24 to 48h of life.ResultsBaseline characteristics and hemodynamic parameters were comparable. Mean PI [1.18 (0.26)] and RI [0.65 (0.08)] in UCM group was comparable to mean PI [1.18 (0.25)] and RI [0.65 (0.08)] in DCC group. The peak systolic velocity and end diastolic velocity (cm/s) of blood flow in MCA for UCM group were 34.94 (11.82) and 11.71 (4.75) respectively, while in DCC group they were 37.24 (12.63) and 13.07 (4.78) (p 0.23 and 0.07) respectively. Indices among growth retarded babies were not different.ConclusionsDCC and UCM had similar effect on cerebral blood flow velocities and Doppler indices in MCA, in term neonates.

Controversies on Protein Supplementation in Neonates

Premature neonates have greater nutritional needs in early neonatal period. They often have high requirements due to medical illness that increase their energy requirements. Vigorous nutritional support is needed to correct growth restriction and promote growth which is almost twice that of a term infant. However, it is also important to avoid rapid advances in feeding, which may result in feeding intolerance or Necrotizing Enterocolitis (NEC). Parenteral Nutrition (TPN) is necessary for neonates whose immaturity or medical condition precludes enteral feeding. TPN includes protein as amino acids, fats as lipids, carbohydrate as glucose, electrolytes–sodium, potassium, chloride, calcium and magnesium, Metals/Trace elements–Zinc, copper, manganese, chromium and selenium. All fat and water soluble vitamins like A, C, D, E, K, thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, biotin; choline and folic acid are also included.

Comparison of Umbilical Cord Milking and Delayed Cord Clamping in Term Neonates: A Randomized Controlled Trial

Perinatal iron deficiency has received little attention in the past, due to assumption that infants are protected from iron deficiency unless the mother is markedly anemic. In a survey in India, 70% of infants between 6 and 11 months of age were found anaemic [1].

Crouzon Syndrome with Bony Upper Airway Obstruction: Case Report and Review Literature

Crouzon syndrome is a rare genetic disorder. It is inherited as an autosomal dominant pattern. Mutations in the FGFR2 gene are known to cause Crouzon syndrome. Craniofacial abnormalities are common at birth and may progress with time. The severity of these signs and symptoms varies among affected children. A full term, large for date, male baby was delivered to a gravida 2 mother by cesarean section having facial dimorphism suggestive of Crouzon syndrome. Genetic team confirmed the diagnosis. Baby had severe respiratory distress. On work up, upper bony airway narrowing was found (diameter 3 mm). Later on, baby was operated for the same. Baby is asymptomatic now and doing well up to 2 months of follow-up. Management of Crouzon disease is multidisciplinary and early diagnosis has prime importance. Follow-up must ensure late features like hearing problems, vision problems, dental problems, intelligence, cranial synostosis, and upper airway problems.