Objective To compare the level of continuous positive airway pressure (CPAP) delivered by three different CPAP delivery interfaces (RAM cannula system, Hudson prongs, and nasal mask) in preterm neonates with respiratory distress. Methods Preterm neonates with gestation between 28 weeks and 34 weeks and birth weight more than or equal to 1000 g and requiring nasal CPAP for respiratory distress were eligible for the study. During the study period, consecutive infants requiring CPAP were started on Hudson prongs or RAM cannula or nasal mask in that order. We measured the mean oropharyngeal pressure, which approximates the applied CPAP level. Oropharyngeal pressures in the recruited neonates were measured between 24 and 48 hours of postnatal age, when stable and in sleep or quiet awake state. Comparison of the delivered oropharyngeal pressures when on three different nasal interfaces at the same set flow rate and at set CPAP of 5 cm or 6 cm of H2O was the primary outcome. Results Data was analyzed from 30 neonates in each group. We found that measured oropharyngeal pressures were less than set CPAP level in all three studied interfaces. Maximum drop in oropharyngeal pressure was observed with use of RAM cannula with measured oropharyngeal pressures being 1.1 and 1.2 cm H2O less than set CPAP of 5 and 6 cm H2O respectively. Pharyngeal pressure best correlated to set CPAP level with the use of nasal mask. Conclusion None of the nasal interfaces delivered oropharyngeal pressure equivalent to the set CPAP. However, nasal mask delivered oropharyngeal pressure best matched to the set CPAP.

Introduction Early diagnosis and appropriate management of neonatal jaundice is crucial in avoiding severe hyperbilirubinemia and brain injury. A low-cost, minimally invasive, point-of-care (PoC) tool for total bilirubin (TB) estimation which can be useful across all ranges of bilirubin values and all settings is the need of the hour. Objective To assess the accuracy of Bilistick system, a PoC device, for measurement of TB in comparison with estimation by spectrophotometry. Design/methods In this cross-sectional clinical study, in infants who required TB estimation, blood samples in 25-µl sample transfer pipettes were collected at the same time from venous blood obtained for laboratory bilirubin estimation. The accuracy of Bilistick in estimating TB within ±2 mg/dl of bilirubin estimation by spectrophotometry was the primary outcome. Results Among the enrolled infants, 198 infants were eligible for study analysis with the mean gestation of 36 ± 2.3 weeks and the mean birth weight of 2368 ± 623 g. The median age at enrollment was 68.5 h (interquartile range: 48–92). Bilistick was accurate only in 54.5% infants in measuring TB within ±2 mg/dl difference of TB measured by spectrophotometry. There was a moderate degree of correlation between the two methods (r = 0.457; 95% CI: 0.339–0.561, p value < 0.001). Bland–Altman analysis showed a mean difference of 0.5 mg/dl (SD ± 4.4) with limits of agreement between −8.2 and +9.1 mg/dl. Conclusion Bilistick as a PoC device is not accurate to estimate TB within the clinically acceptable difference (±2 mg/dl) of TB estimation by spectrophotometry and needs further improvement to make it more accurate.

Placental examination can yield valuable information that may be essential to enhance our understanding of disease pathogenesis and to identify underlying causes of adverse pregnancy outcomes. There is increasing evidence that COVID-19 infection leaves tell-tale signs of injuries in the placenta. To study histopathological features of placenta of covid 19 positive mothers. Prospective observational study. Out of fifteen placenta histopathological changes observed, intervillous fibrin deposition was most common finding that was present in 6 placenta (40%); calcifications, chorangiosis in 4 placenta(26.6%); deciduitis, thrombosis were present in 3 placentas(20%)respectively; increased fibrinoid material, decidual vasculopathy, chorioamnionitis were present in 1 placenta(6.6%)respectively. Out of fifteen infants, 13(86.6%) infants were term (>37weeks) and 2(13.3%) infants were preterm (<37 weeks) including one twin delivery. Two (13.3%) infants were IUGR and 3 (20%) infants were low birth weight and Small for gestational age. Six infants (40%) required admission in NICU of which 5 infants (33.3%) required respiratory support. Placenta histopathological findings were suggestive of maternal vascular malperfusion like increased intervillous fibrin deposition, chorangiosis, deciduitis, calcifications, thrombosis and the findings were correlated with fetal outcome like preterm deliveries, small for gestational age, IUGR, respiratory distress requiring respiratory support.