Sushma Nangia

End tidal carbon dioxide monitoring--its reliability in neonates.

End tidal Carbon dioxide monitoring was undertaken prospectively in all Ventilated neonates in our NICU admitted from March 1995 to August 1995 irrespective of the birth weight, gestational age and indication of ventilation. The aim was to determine the correlation between ETCO2 and PaCO2 in various clinical situations. The arterial blood gases were obtained in all ventilated babies with simultaneous and continuous ETCO2 monitoring and were analysed by AVL 995 Hb blood gas analyser. ETCO2 was analysed by side stream technique by Datex Cardiocap II monitor. A total of 152 samples from in-dwelling radial artery catheters were analysed from babies with birth weight from 900 g to 3400 g, gestation age from 28 to 42 wks and were ventilated for various indications like Severe Birth Asphyxia (SBA), Meconium Aspiration Syndrome (MAS), Recurrent Apnoea and Hyaline Membrane Disease (HMD). Statistical analysis was done in 10 groups to see if the ETCO2 correlated with its corresponding PaCO2 value. The study groups comprised three groups based on birth weight being <1.5–2.5 kg and >2.5 kg three groups as per the gestational age being 28–31+6 wks, 32–36+6 wks and 37–41+6 wks and four groups as per the need for ventilation being Severe Birth Asphyxia, Meconium Aspiration Syndrome, Apnoea of Prematurity and Hyaline Membrane Disease. Results of the correlation analysis revealed that the correlation coefficient in the study group ranged from 0.55 to 0.96 and was statistically significant in babies >2.5 kg and 1.5–2.5 kg, in term and preterms 32–36 wks, and in babies with MAS, SBA and Recurrent Apnoea. The correlation coefficient was lowest in babies with HMD, being 0.55. The study showed that ETCO2 correlates closely with PaCO2 in most clinical situations in neonates and we recommend its use in all level III NICUs in ventilated babies.

Free oxygen radicals--predictors of neonatal outcome following perinatal asphyxia.

The study was undertaken to evaluate the role of free oxygen radicals in asphyxiated neonates. Thirty term neonates appropriate for gestational age and with severe birth asphyxia (Apgar score of 3 or less at 1 minute of life) formed the study subjects.The levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), creatine phosphokinase (CPK) and lipid peroxidase (LPO) in the CSF of these neonates were estimated between 12 and 48 hrs of life. Enzyme estimation was performed by standard methods and the results were analysed statistically using Multivariate Logistic Regression analysis and non parametric tests namely Kruskal Wallis test and Wilcoxon’s rank sum test.Out of the thirty babies, 14 were observed to be neurologically normal, 9 had significant morbidity and 7 died. The SOD levels ranged from 12.4 to 140 units/ml, GPx from 128 to 1933 nmol/min/dl, CPK from 2 to 2098 IU/dl and LPO from 5.4 to 30.8 umol/hr/dl. The SOD and GPx levels had an inverse relationship whereas rise in LPO and CPK levels were directly proportional to the extent of neurological damage and ultimate clinical outcome. CPK levels higher than 140 IU/ml were lethal and associated with 100% mortality whereas, all normal neonates had CPK below 37 IU/ml.The levels of antioxidant enzymes can reliably and significantly predict mortality and morbidity whereas level of an enzyme cannot confidently confer normalcy. Hence antioxidant enzyme levels with a cut off value can be a useful marker and serve as a prognostic indicator in times to come.

Congenital Rickets Presenting as Refractory Respiratory Distress at Birth

Congenital rickets is a very rare entity in the spectrum of metabolic bone disease in children. The authors report an as yet unreported case of congenital rickets presenting with respiratory distress at birth. The radiographs of long bones and wrist showed generalized osteopenia with cupping and fraying of epiphyseal ends in the second week of life. The patient was managed with very high doses of vitamin D which led to clinico-radiological and biochemical improvement. More than being interesting for its extreme rarity, this report assumes importance as it brings forth the possibility of congenital rickets being a differential diagnosis for a newborn with respiratory distress.

Seroconversion Following Killed Polio Vaccine in Neonates

The study was carried out to evaluate the efficacy of IPV in neonates and to study the additive effect of IPV or OPV at birth on seroconversion with three subsequent doses of OPV. Addition of IPV or OPV at birth to the conventional OPV schedule resulted in significantly higher seroconversion rates than in the controls, who received three doses of OPV. Three doses of IPV beginning from birth resulted in significantly better seroconversion rates than in the control group. Children receiving 3 doses of IPV showed significantly greater seroconversion rates against type III polio virus than those receiving IPV/OPV at birth followed by 3 doses of OPV. The difference in the seroconversion rates against the other virus types was not significant.A significantly greater number of children who received some vaccine at birth (IPV or OPV) were protected against poliomyelitis by 6 weeks age as compared to those who received no immunization at birth. The study recommends that seroconversion rates following three doses of IPV are satisfactory. Addition of IPV or OPV at birth to the conventional schedule markedly increases the seroconversion rates. Immunization can be started at birth to ensure early protection against poliomyelitis.

Topical Oil Application and Trans-Epidermal Water Loss in Preterm Very Low Birth Weight Infants—A Randomized Trial

OBJECTIVE Topical emollient application reduces trans-epidermal water loss (TEWL) in preterm neonates. Coconut oil used traditionally for infant massage in India has not been evaluated for the same. PATIENTS AND METHODS Very low birth weight (VLBW) neonates were randomized at 12 h of age to Oil (n = 37) or Control (n = 37) groups. Oil group neonates received twice-daily coconut oil application without massage, and Control group received standard care. TEWL was measured every 12 h using an evaporimeter till Day 7 when skin swabs were obtained for bacterial growth and skin condition was assessed using a validated score. RESULTS Birth weight (g; mean ± SD: 1213 + 214 vs. 1164 + 208, p = 0.31), gestation [week; median (interquartile range): 32 (31-33) vs. 32 (29-33), p = 0.10] and other baseline variables were comparable. TEWL was significantly reduced (g/m(2)/h, mean difference: -6.80, 95% confidence interval: -3.48, -10.15; p < 0.01) with better skin condition and lower bacterial growth in the Oil group (20% vs. 60%, p < 0.01). CONCLUSION Coconut oil application reduced TEWL without increasing skin colonization in VLBW neonates. CLINICAL TRIALS REGISTRATION NCT01758068.

Failure to Thrive

Failure to thrive is poor physical growth that results when the nutritional demands of young children are not fulfilled. This diagnosis is made when, on serial growth monitoring, the child’s anthropometric parameters such as weight for age and/or height are found to be significantly below the expected values. A detailed evaluation by the treating physician, taking into account physical and psychosocial factors affecting the child’s health is essential for understanding the factors contributing to failure to thrive. The treatment of this entity requires a multidisciplinary approach, correcting the macro and micronutrient deficiency in the child as well as education of parents regarding age-appropriate feeding recommendation for children. In addition, parents need to be apprised of the possible implications of malnutrition on growth and neurodevelopment of the child. Early childhood being a crucial period for growth and development, an early diagnosis and treatment will result in better outcomes in children with failure to thrive.

Meconium aspiration syndrome: challenges and solutions

php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Research and Reports in Neonatology 2017:7 19–28 Research and Reports in Neonatology Dovepress

Prospective analysis of risk factors associated with group B streptococcal colonisation in neonates born at a tertiary care centre in India

Abstract Background: Bacterial colonisation of neonates and the birth canal by group B streptococci (GBS) plays a significant role in the development of neonatal infections. Objectives: To determine the rate of GBS colonisation in neonates in the first 48 hours of life and to identify the risk factors associated with GBS colonisation. Methods: To estimate GBS colonisation, a prospective cross-sectional analysis of 1050 neonates delivered at a tertiary care hospital in India was undertaken. Swabs were taken from the neonates’ skin and/or mucus membranes of the external ear canal, anterior nares, umbilicus, throat and ano-rectal sites between 24 and 48 hours of age. Data regarding the various risk factors were collected on a predesigned performa. Results: 338 (32·2%) of 1050 neonates had bacterial colonisation. Escherichia coli (25·9%), was the bacteria most commonly isolated, followed by Staphylococcus aureus (16·3%) and coagulase-negative Staphylococci (CONS) (12·6%). The overall rate of GBS colonisation was 3·23%. Preterm birth, respiratory distress at birth, prolonged rupture of membranes (≧18 hrs), intrapartum antibiotics, underlying medical illness in the mother, prolonged labour, maternal fever and other obstetric complications were identified as significant risk factors associated with neonatal GBS colonisation (P<0·05). Conclusion: Multi-centre and community-based studies in India are recommended to identify the true colonisation rates for GBS, and it is necessary to perform cultures from multiple body sites of neonates in order to obtain an accurate bacteriological evaluation.

Yield of meconium in non-vigorous neonates undergoing endotracheal suctioning and profile of all neonates born through meconium-stained amniotic fluid: a prospective observational study

ABSTRACT Background: Delivery room management of infants born via meconium-stained amniotic fluid (MSAF) is quite controversial. No study has tried to quantify the amount of meconium that can be aspirated from the trachea of a non-vigorous neonate born through MSAF. Aims: To study the yield of meconium in non-vigorous neonates born through MSAF undergoing endotracheal (ET) suctioning. Methods: This was a prospective observational study conducted from 1 March 2015 to 31 October 2015. A total of 760 neonates born through MSAF were enrolled. All non-vigorous neonates underwent ET suctioning. Meconium aspirated was quantified as nil (no meconium aspirated), insignificant (when only streaks of meconium were present in the ET tube), minimal (when the whole length of ET tube was filled with meconium) and significant (when the whole ET tube was filled with meconium and it poured into the suction tubing or when repeat suctioning was required). Results: The amount of meconium aspirated from the trachea was nil to insignificant in 46% of the neonates who underwent tracheal suctioning. Only 14.4% of the neonates had significant meconium aspirated from the trachea. Almost 46% of the non-vigorous infants underwent tracheal suctioning without any important amount of meconium being aspirated from the trachea. Conclusion: The study further supports the recommendation put forth by the International Liaison Committee on Resuscitation (ILCOR) 2015 that selective intubation and tracheal suctioning of non-vigorous MSAF neonates might be of limited benefit. Abbreviations: ET: endotracheal; ILCOR: International Liaison Committee on Resuscitation; HIE: hypoxic ischaemic encephalopathy; LMIC: low- and middle-income countries; MAS: meconium aspiration syndrome; MSAF: meconium-stained amniotic fluid; NRP: neonatal resuscitation programme; PPHN: persistent pulmonary hypertension of the newborn; RCT: randomised controlled trial.

Surfactant Lung Lavage vs. Standard Care in the Treatment of Meconium Aspiration Syndrome—A Randomized Trial

OBJECTIVE The objective of this study was to evaluate the effect of surfactant lung lavage (SLL) on duration of respiratory support in neonates with meconium aspiration syndrome (MAS). PATIENTS AND METHODS Sixty term infants with MAS who had moderate to severe respiratory distress (Downes score >4) were randomized toSLL (n = 31) or no lung lavage-NLL (n = 29). Neonates in intervention group underwent lung lavage with dilute surfactant and those in control group were managed as per unit protocol. RESULTS The median duration of respiratory support was 34 h in SLL group and 44 h in NLL group (p value = 0.994). The duration of oxygen therapy post-respiratory support decreased by 78% in SLL as compared with NLL group (4 vs. 18 h) (p value = 0.005). Lavage procedure was well tolerated with fall in mean heart rate by just 20/min and in mean saturation drop by just 6% during the procedure. CONCLUSION Lung lavage is well tolerated by neonates, but it does not alter overall duration of respiratory support.