Vikram Datta

Effect of Sucrose Analgesia, for Repeated Painful Procedures, on Short-term Neurobehavioral Outcome of Preterm Neonates: A Randomized Controlled Trial.

BACKGROUND Safety of oral sucrose, commonly used procedural analgesic in neonates, is questioned. AIM To evaluate the effect of sucrose analgesia, for repeated painful procedures, on short-term neurobehavioral outcome of preterm neonates. METHODS Stable preterm neonates were randomized to receive either sucrose or distilled water orally, for every potentially painful procedure during the first 7 days after enrollment. Neurodevelopmental status at 40 weeks postconceptional age (PCA) measured using the domains of Neurobehavioral Assessment of Preterm Infants scale. RESULTS A total of 93 newborns were analyzed. The baseline characteristics of the groups were comparable. No statistically significant difference was observed in the assessment at 40 weeks PCA, among the groups. Use of sucrose analgesia, for repeated painful procedures on newborns, does not lead to any significant difference in the short-term neurobehavioral outcome.

Comparison of the Efficacy of Oral 25% Glucose with Oral 24% Sucrose for Pain Relief during Heel Lance in Preterm Neonates: A Double Blind Randomized Controlled Trial

Aim: To study the analgesic effect of oral 25% glucose as compared with oral 24% sucrose during heel lance in preterm neonates. Methods: Stable preterm neonates within first 48 hours of life were randomized to receive either 24% sucrose or 25% glucose before heel lance. Primary outcome assessed was painful response by the Premature Infant Pain Profile (PIPP) score at 30 seconds after heel lance, and the secondary outcome was immediate adverse events associated with the administration of two solutions and duration of crying immediately following the procedure. Results: A total of 94 neonates were randomly assigned into 24% sucrose and 25% glucose group. The baseline characteristics between the two groups were comparable. No significant difference was observed between the two study groups with respect to PIPP scores, duration of crying and rate of adverse events. Conclusions: When assessed by PIPP score, 25% glucose and 24% sucrose provided comparable analgesia during heel lance in preterm neonates.

Neonaticide in India and the stigma of female gender: report of two cases

Abstract Neonaticide is known to occur across the globe in both developed and developing countries, but has rarely been reported from India. Two similar cases of female neonaticide are presented which were committed by their mothers while in the maternity ward. The social issues and maternal provocation highlighted in this report are different from those reported in world reviews of neonaticide.

Umbilical artery pH at birth and neurobehavioral outcome in early preterm infants: A cohort study.

Objective: The objective of the following study is to determine the effect of umbilical artery pH at birth on early neurobehavioral outcome of preterm infants as assessed by Neurobehavioral Assessment of Preterm Infants (NAPI) tool. Materials and Methods: Prospective cohort study conducted at the neonatal unit in a tertiary care center in North India. Preterm neonates < 34 weeks of gestation were enrolled at birth and divided into cases (umbilical artery pH < 7.2) and controls (umbilical artery pH > 7.2). At 34 weeks postconceptional age, the motor development and vigor (MDV) and alertness and orientation (AO) domains of neurobehavior were assessed by NAPI and compared among groups. Results: Hundred preterm neonates were enrolled in the study out of which 76 (30 cases and 46 controls) were finally analyzed. The groups were comparable in terms of gestational age, mode of delivery, birth weight and requirement of resuscitative measures at birth. There was no significant difference in incidence of meningitis, intraventricular hemorrhage, jaundice and hypoxic ischemic encephalopathy among the groups; however hypoglycemia was observed more commonly among cases. The MDV score (mean ± standard deviation [SD] [95% confidence interval]) was found to be significantly lower among cases compared to controls (37.0713 ± 13.616 [32.099-42.0431] vs. 47.506 ± 14.0692 [43.367-51.655]) (P = 0.002). Similarly, lower AO scores were observed among the cases. Conclusion: A low umbilical artery pH at birth is a predictor of poor early neurobehavioral outcome in preterm neonates.

Therapeutic Hypothermia for Birth Asphyxia in Neonates

India contributes to the highest neonatal mortality globally. Birth asphyxia is one of the leading causes of neonatal mortality in India. A large number of neonates who suffer from birth asphyxia progress to Hypoxic Ischemic Encephalopathy (HIE). The risk of a neonate progressing to severe form of HIE is many times higher in the low and middle income countries (LMICs) with ill developed health infrastructure. Till date LMICs have had a low institutional delivery rate, poor regionalization of care, lack of adequate transport facilities and ill equipped neonatal intensive care facilities. This has lead to a tremendous burden on the health care systems with a cohort of developmentally challenged neonates surviving into adulthood. Recently, Therapeutic Hypothermia (TH) has emerged as an evidence based intervention to reduce mortality and neurodevelopmental disability associated with asphyxia induced encephalopathy. TH has become the gold standard in the management of such cases in the western world. Extension of this knowledge to the LMICs and countries like India require a better understanding of the unique sociocultural issues associated with asphyxial brain injury in neonates. The high incidence of sepsis and presence of economic constraints make this problem more complex in such countries. The current review has tried to address these issues and looked at the basics of this complex topic from the perspective of a general pediatrician.

Reducing hypothermia in newborns admitted to a neonatal care unit in a large academic hospital in New Delhi, India

Neonatal hypothermia is a common and dangerous condition around the world. 70% of neonates born in Kalawati Saran Children’s Hospital in New Delhi, India, and subsequently admitted to the neonatal intensive care unit (NICU) had a temperature below 36.5°C on admission. In July 2016, we formed a team of staff from the labour room, NICU and auxiliary staff to reduce hypothermia in babies transported to our NICU using quality improvement methods. We identified problems related to staff awareness of hypothermia and its dangers, environmental factors and supply issues in the labour room, and challenges with rapidly and safely transferring sick newborns to the NICU. We used the Plan-Do-Study-Act cycles to test and adapt solutions to these problems. Because infection is a common complication of hypothermia, we also instituted a training programme to improve handwashing skills among parents and health workers. Within 9 months of starting our quality improvement project, the proportion of neonates who were normothermic on admission increased from 27% to 75%, the number of cases of late-onset neonatal sepsis decreased from 15.2 to 5 cases/1000 patient days, and all-cause mortality fell from 4.2 to 2.6 neonatal deaths per week. Multiple factors can lead to neonatal hypothermia, and the most important factors will differ from facility to facility. Quality improvement methods provide health workers with the skills to identify the key factors contributing to hypothermia in their facility and to develop strategies to address them. Addressing processes of care can lead to improved thermal care and save lives.

A Randomized Controlled Trial to Evaluate the Role of Brief Delay in Cord Clamping in Preterm Neonates (34–36 weeks) on Short-term Neurobehavioural Outcome

Aim To study the effect of brief delay in cord clamping on short-term neurobehavioural outcome of preterm neonates. Methods All preterm neonates born between 34-36 weeks and 6 days were included and randomized into either a control or intervention group. In the control group, clamping was done within 20 s after delivery, and this was termed as immediate cord clamping (ICC). In the intervention group, delayed cord clamping (DCC) took place between 30 and 60 s. A total of 120 preterm neonates were enrolled. The primary outcome studied was short-term neurobehavioural outcome at 37 weeks after conceptional age using the Neurobehavioral Assessment of Preterm Infants (NAPI) score as the outcome measure. Results NAPI scores at 37 weeks of corrected gestational age revealed a mean (95% confidence interval) score of motor development and vigour of 64.21±27.31 (57.27 - 71.14) vs. 76.69±25.29 (70.04-83.34), p = 0.01; and alertness and orientation of 29.31±12.78 (26.06-32.55) vs. 42.77±15.75 (38.63-46.91), p = 0.00 across the ICC vs. DCC groups, respectively. Conclusion A brief delay of 30-60 s in cord clamping is beneficial in improving neurobehavioural outcome of late preterm infants.

Neonatal stretched penile length: relationship with gestational maturity and anthropometric parameters at birth

Abstract Background: It is inappropriate to use universal cut-off points to interpret stretched penile length (SPL) measurements in newborns with variable body dimensions. Aim: To assess neonatal SPL on the basis of gestational maturity and anthropometric parameters at birth. Methods: A cross-sectional observational study of SPL was conducted on stable newborns at a referral teaching hospital in north India between January and June 2012. Gestational maturity, SPL and anthropometric parameters (weight, length, head circumference and foot length) were recorded within 24 hours of birth. Variation of SPL in relation to gestational age and anthropometric parameters were evaluated using multiple linear regression models. The equation using lower confidence limits of 95% confidence intervals for the correlation co-efficients provides cut-off points to define a small penis. Results: Data from 1249 newborns demonstrated that penile growth follows the pattern of increase in body dimensions in newborns. SPL can be predicted best in relation to body and foot length taken together. Conclusions: SPL should be interpreted in relation to anthropometric parameters in newborns, particularly body and foot length.

Congenital Rubella Syndrome

Sir, Congenital Rubella Syndrome (CRS) is a transplacentally acquired rubella infection which leads to multiple organ defects. We are presenting three babies with CRS diagnosed within a span of 2 mo. The first patient was a premature (35 wk), baby girl born with an Apgar score (AS) of 7, 8. On day one, she had bluish-purplish papulo-nodular, non blanchable and non tender rash over the cheeks, trunk and upper limbs (Fig. 1). The rash was identified as blueberry muffin rash and confirmed on skin biopsy. She was diagnosed with CRS. The echocardiogram showed mild valvular pulmonary stenosis (PS) with a patent foramen ovale. The baby was discharged on day 18. She has been followed till the age of 2 y and is presently having global developmental delay. She has been referred to the ENT department for hearing impairment. The second patient was a preterm (34 wk) baby (AS 8, 9), who also had blueberry muffin rash on day 1. He also had a small patent ductus arteriosus (PDA). He was diagnosed as CRS. The baby was discharged on day 16. The third patient was a term baby boy, born vaginally (AS 7, 9). At birth, this baby had bilateral corneal opacities, diagnosed as buphthalmos (Fig. 2). The echocardiogram revealed Tetralogy of Fallot (TOF), with PS, with PDA and a septum secundum Atrial Septal Defect (ASD). The diagnosis of

Persistent postnatal depression after preterm delivery

The researchers considered the effects of preterm birth on the mother and the resulting anxiety and depression which can persist even after the stressful circumstances have been resolved.