The authors prospectively studied ionizing radiation exposure in consecutive 107 very low birth weight (VLBW) neonates, admitted to their Level III neonatal intensive care unit (NICU). Number of X-rays, their indications and calculated dose of radiation were documented. Their mean birth weight (+SD) and gestational age (+SD) were 1077 (±219.8) g and 29.7 (+2.57) wk respectively. Extremely low birth weight (ELBW) neonates underwent significantly higher radiographs when compared with VLBW neonates; 7.5(5-13.25) vs. 2(1-6); p < 0.0001. ELBW neonates received 3 times higher dose of radiation, when compared with VLBW neonates; 139.4 μsv (81.6-256.15) vs. 46.6 μsv (14.4-115.7); p < 0.0001. Seven percent of ELBW neonates received >1msv radiation. Lifetime risk associated with high radiation exposure during neonatal period is unknown. Every effort should be taken to reduce number of radiographs. Imaging modalities without radiation exposure such as, point of care ultrasound should be used wherever possible.
Aim: To find out the diagnostic use of lung ultrasound (LUS) in respiratory distress in neonates by taking clinico-radiological (clinical plus X-ray) diagnosis as the gold standard. Secondary objectives were to find out if modified LUS score can predict the need for surfactant therapy. Methods: A prospective observational study was done in a tertiary care neonatal intensive care unit over a period of 1 year (January–December 2018). All pre-term infants with respiratory distress were screened with LUS and CXR within 2 h of admission and modified LUS score was calculated to find out the lung water content and its correlation with the severity of respiratory distress syndrome (RDS). Results: In total, 92 neonates were screened during the study period, and 61 were finally diagnosed as RDS. The Kappa statistic between the clinico-radiological diagnosis and LUS diagnosis was 0.639. LUS diagnosis and CXR diagnosis had a Kappa correlation value of 0.786 (95% CI: 0.678–0.983). The most common LUS feature in RDS was pleural line thickening (100%), followed by whiteout lungs (75.4%). The modified LUS score was higher in babies who needed surfactant therapy (median (IQR): 49 (44, 53.5) vs. 29.5 (21, 46)) ( P < 0.0001). Conclusion: Our study shows that LUS in neonatal RDS can predict the severity of the disease, need for surfactant therapy and has good agreement with clinical and Xray diagnosis.
Background: Kangaroo mother care (KMC) is an evidence based approach to reduce mortality and morbidity in preterm neonates. Knowing nurses’ perception to early initiation of KMC will help scale-up this intervention. This study aimed to know barriers to early initiation of KMC in neonates weighing ≤1250 grams among nurses and effect of structured training programme on their perception and KMC provision.Methods: A prospective COHORT study was conducted at level three NICU where 40 nurses were interviewed by a predesigned questionnaire followed by KMC training and practice phase. Repeat survey was conducted at the end of the study to know change in nursing perception.Results: Two themes identified from the pre KMC training questionnaire were: Infant related barriers and nursing practice related barriers. Among infant related barriers KMC training significantly reduced nurses’ hesitation for KMC initiation in neonates with gestation age <28 weeks (45% to 20%), invasive ventilation (55% to 25%), UVC in situ (70% to 50%) and PICC in situ (52.5% to 22.5%). Nurses also felt more confident to continue KMC for longer hours (p value 0.002). Post KMC training initial day of KMC provision improved from 4.8 (±0.89) to 3.8 (±0.83).Conclusions: Identification of barriers to early KMC initiation and addressing them by standardized comprehensive training programme improves nurses’ perception and
Background: Pneumonia is the most common cause of childhood morbidity and mortality in age group less than 5 years. Identification of causative organism is a real challenge in these children though many of them are responding to the first line antibiotics therapy. Isolation of the organism is of paramount importance those who fails to respond to first line therapy. The objective of this study was to determine the relative efficacy of Bronchoalveolar Lavage (BAL) over blood culture in finding out causative organisms of childhood non responder community acquired pneumonia and to study antibiotic-sensitivity pattern of causative organisms. Methods: BAL and blood culture was performed in 17 patients of age 2 months to 5 years with pneumonia or severe pneumonia. Lavage fluid was cultured and growth of organism 10000CFU/ml was considered positive. Blood culture was taken on the same day. Antibiotic sensitivity was tested.Results: BAL isolated the organism in 82.35% (n=14) cases out of 17 patients and in 11.76% (n=2) by blood culture (p=0.002). Streptococcus pneumoniae was the most common organism isolated (58.82% (n=10)), followed by K. pneumoniae (23.53% (n=4)). Antibiotic therapy was changed in 58.82% (n=10) cases according on culture report. Transient rise in temperature, tachycardia and tachypnea was noted after procedure but no major complication was associated with BAL.Conclusions: BAL fluid culture in childhood pneumonia has high diagnostic value and better efficacy over blood culture in isolating causative organism without increased risk of complication and decreases unwanted exposure to empiric antibiotic in children with community acquired pneumonia who did not respond to initial 1st line therapy.
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