Umesh Vaidya

Bubble CPAP versus Ventilator CPAP in Preterm Neonates with Early Onset Respiratory Distress—A Randomized Controlled Trial

UNLABELLED Bubble continuous positive airway pressure (BCPAP) is a low cost nasal CPAP delivery system with potential benefits to developing nations. OBJECTIVE To compare the efficacy and safety of BCPAP with ventilator-derived CPAP (VCPAP) in preterm neonates with respiratory distress. METHODS In a randomized controlled trial, preterm neonates with Silverman-Anderson score ≥ 4 and oxygen requirement >30% within first 6 h of life were randomly allocated to BCPAP or VCPAP. Proportion of neonates with success or failure was compared. RESULTS In all, 47 of 57 (82.5%) neonates from BCPAP group and 36 of 57 (63.2%) neonates from the VCPAP group completed CPAP successfully (p = 0.03). Neonates who failed CPAP had higher Silverman-Anderson score (p < 0.01), lower arterial to alveolar oxygenation ratio (p < 0.05) and needed surfactant more frequently (p < 0.01). CONCLUSION BCPAP has higher success rate than VCPAP for managing preterm neonates with early onset respiratory distress, with comparable safety.

A Pilot Study of Comparison of BCPAP vs. VCPAP in Preterm Infants with Early Onset Respiratory Distress

BACKGROUND Bubble continuous positive airway pressure (BCPAP) is a low-cost nasal CPAP delivery system with potential benefits for developing nations. The objective of the study was to compare the efficacy and safety of BCPAP with ventilator CPAP (VCPAP) in preterm neonates with moderate respiratory distress. METHODS In a pilot randomized controlled trial, 30 preterm neonates (gestation <37 weeks) with Silverman-Anderson score between 5 to 7 and oxygen requirement >30% within first 6 h of life were randomly allocated to BCPAP or VCPAP after informed parental consent. Proportion of neonates with success or failure, while using the allocated mode of CPAP delivery (primary outcome) was compared. RESULTS The success rate was comparable [VCPAP: 80% (12/15) vs. BCPAP: 87% (13/15)] between the two groups. Dislodgement was commonest problem with equal frequency [10/15, (67%)] in each group. CONCLUSION BCPAP appears to be a promising method of CPAP delivery in preterm neonates with moderate respiratory distress.

Parenteral nutrition in the management of severe protracted diarrhea

Seventeen children aged 3 weeks to 19 months with severe Protracted Diarrhea (PD), and who were deteriorating on our standard management protocol (including special diets) were given parenteral Nutrition (PN) for 4 to 19 days with crystalline aminoacid solution (Vamin N) in 10% dextrose and lipid emulsion (Intralipid 10%). Peripheral lines were used in majority (84%). Enteral feeds were started early and rebuilt as per tolerance. The mean daily protein and caloric intake achieved by hyperalimentation was 2.2±0.7g/kg and 106±41 K cal/kg respectively. Diarrheal control and improvement in nutritional status was achieved in all but 4 who died (2 of refractory diarrhea and 2 of sepsis, 1 of which was probably PN related). Other PN related, treatable complications included thrombophlebitis (11.8%), sepsis (17.6%), and metabolic imbalance (17.6%). PN solutions and accessories alone cost an approximate average of Rs. 280/day, with extras for biochemical monitoring (Rs.70/Jay) and special nursing (Rs. 200/day). Only 5 of the 13 survivors had a significant relapse of PD, within 5 to 80 days of discharge, necessitating further PN in 2. There were no further deaths. PN was therefore, found to be of life saving value in 13 of 17 children with severe protracted diarrhea and therefore, must be available in specialised units caring for such children.

Multidrug resistant Klebsiella pneumoniae in NICU – what next? Trend of antibiotic resistance

Multidrug resistant (MDR) Klebsiella pneumoniae an increasing cause of neonatal sepsis in India. This observational study was designed to monitor temporal change in prevalence of K. pneumoniae as a causative organism for neonatal sepsis and its sensitivity pattern. The time period was divided into four time frames of six months each (designated A (1/10/2006-31/03/2007) to D (1/04/2008-30/09/2008)). K. pneumoniae isolation in all cultures sent from neonatal intensive care units doubled in time frame D (6.3%) compared to time frame A (3.0). Similarly, the percentage of total positive cultures in the neonatal intensive care unit that were K. pneumoniae also doubled (27.8% in A to 55.6% in D). K. pneumoniae sepsis tripled in inborn neonates (15.4% in A to 47.1% in D). Incidence of MDR K. pneumoniae increased from 0% in time frame A to 76.5% in time frame D. Resistance against ampicillin and third generation cephalosporins (cefotaxime and ceftazidime) remained 100% in all time frames. Carbapenem (meropenem and imipenem) resistance increased from 0% in time frame A and B to 41.2% in time frame D. Death due to K. pneumoniae sepsis showed brisk resurgence in time frame D (17.6%) compared to time frame C (10%). Lower gestational age and birth weight were associated with higher mortality. MDR K. pneumoniae is emerging as a more frequent cause of neonatal sepsis. There is an dincreasing threat of combined quinolone and carbapenem resistant MDR K. pneumoniae.

Spontaneous Pneumopericardium in a Healthy Full-Term Neonate

Pneumopericardium is rare in neonates and might be of serious clinical significance. Neonatal pneumopericardium is usually a complication of mechanical ventilation in premature infants with respiratory distress syndrome. Here, the authors report a full-term neonate who developed spontaneous pneumopericardium which resolved spontaneously.

Aggressive parenteral nutrition in sick very low birth weight babies: a randomized controlled trial.

Survival of preterm neonates in developing world has improved. Developing countries lag behind in nutritional management in NICU especially parenteral nutrition (PN). This randomized controlled trial was done to evaluate the effect of aggressive parenteral nutrition on nitrogen retention of sick VLBW and extremely low birth weight (ELBW) babies. From September 2009 to February 2010, total 34 babies were randomized to receive aggressive parenteral nutrition (APN) (n=17) or standard parenteral nutrition (SPN) (n=17). The average daily total and PN calory intake of babies in APN group was significantly higher during first week. APN was well-tolerated; however, nitrogen retention was not significantly higher in APN group. Aggressive parenteral nutrition in sick VLBW babies is feasible in developing world, though it did not improve nitrogen retention in first week of life.

Comparisons of mortality and pre-discharge respiratory morbidities in small for gestational age and appropriate-for gestational age premature infants - An Indian Experience

Background: There is an assumption that fetus with restricted growth with an inappropriate intrauterine environment lies under stress. Although small-for-gestational-age (SGA) infants have higher mortality, difference in the outcome of SGA and appropriate-for-gestational-age (AGA) infants regarding respiratory morbidity is controversial. It seems that respiratory morbidities in SGA neonates is different from neonates with AGA. In this study, we intend to compare the mortality and respiratory morbidity rates between the preterm small for gestational age (SGA) and appropriate for age (AGA) neonates of less than 34 weeks of gestation. Methods: This analytical cross-sectional study was conducted on 498 preterm neonates with gestational age of < 34 weeks, admitted to the Neonatal Intensive Care Unit. These neonates were categorized into two groups of SGA (n=210) and AGA (n=286). The data analysis was performed, using Student’s t-test and Mann-Whitney U test for parametric variables and Chi-square and Fisher’s exact tests for nonparametric data. Results: According to the results of the study, the two groups were significantly different in terms of their birth weight (P<0.001), pregnancy-induced hypertension (P<0.001), and antenatal steroid usage (P=0.011). Furthermore, respiratory distress syndrome (RDS) was found to be more prevalent in the premature AGA neonates than the SGA ones (P=0.011). In addition, surfactant usage was significantly less in the SGA group (P=0.0006). Bronchopulmonary dysplasia (BPD) developed in 14% and 9% of the premature AGA and SGA neonates, respectively (P=0.094). However, there was no significant difference between the two groups regarding the mortality rate, intra-ventricular hemorrhage, and necrotizing enterocolitis. Among the survived neonates, mean length of hospital stay was significantly higher in the premature SGA newborns born within 26-36 weeks of gestation than their AGA counterparts. Conclusion: As the findings of the current study demonstrated, the mortality rate was similar in the SGA and AGA groups; however, the respiratory morbidities such as RDS and BPD were more prevalent in the AGA neonates.