Background: In India, there is high burden of prematurity in newborns due to high birth rate and lack of good antenatal care. The objective of this study was to compare the outcome (efficacy and safety) of Bubble Continuous Positive Airway Pressure (B-CPAP) machine and Indigenous Bubble Continuous Positive Airway Pressure (I-CPAP) as a primary mode of respiratory support in preterm new-borns with respiratory distress syndrome (RDS). It was a prospective observational comparative study conducted at NICU of a tertiary care teaching hospital of western Gujarat, India, from December 2016 to July 2017.Methods: Eighty-one preterm babies <36 weeks of gestation age with respiratory distress (Silverman Anderson scoring >4) within 6 hours of birth were included (out of 182 preterm newborns with respiratory distress syndrome) and put on respiratory support either with B-CPAP machine (n = 48) or with I-CPAP (n = 33). Outcome was compared in the form of CPAP failure, survival and complication rates.Results: There was no significant difference in the demographic profile of patients in both groups except number of neonates between 1.5-2.5 kg birth weight were significantly high in B-CPAP (45.8%) compared to I-CPAP (33.3%) (p = 0.00074). There were no significant differences in CPAP failure rates in B-CPAP (27%) versus I-CPAP (24.2%). The survival rate (72.9% in B-CPAP) versus (75.7% in I-CPAP) in both groups was also similar (CI 95%, p = 0.774). The complications, such as moderate to severe nasal septal damage, occurred significantly more frequent with B-CPAP machine (47.9%) than on I-CPAP (6%) (CI 95%, p = 0.000062).Conclusions: Efficacy of I-CPAP as a primary mode of respiratory support for preterm new-born with respiratory distress was comparable to B-CPAP. The ease with which it can be assembled makes it a suitable alternative to B-CPAP.
Background and Aim: Protein energy malnutrition (PEM) continues to be a major public health problem throughout the developing world. PEM is associated with reduced synthesis of plasma proteins. The present study has been conducted to study the effect of PEM on plasma protein levels. Materials & Methods:The study included children of age group 1-5 years. Two hundred fifty children with PEM were included as cases and 250 healthy children were enrolled as controls. Details were collected in predesigned proforma. Serum total protein by biuret method, serum albumin by bromocresol green dye method and hemoglobin was estimated using auto analyzer. The parameters were compared among cases and controls. Results: Mean hemoglobin, serum total protein, serum albumin levels and A/ G ratio were significantly low in PEM children (cases) as compared to controls. Conclusion: PEM children have low serum total protein and albumin levels as compared to healthy controls. This is probably due to decreased intake of proteins and reduced biosynthesis. PEM children have lower hemoglobin levels as compared to healthy controls; this is probably due to deficiency of iron and other micronutrients, which is often found in a child with malnutrition.
Background: Etiology of hyperbilirubinemia is not only crucial for optimal management of the patient but also it may have implications for subsequent pregnancies. The objective of this study was to study the clinical profile and the underlying aetiological factors leading to neonatal jaundice in this rural setting of Kutch District, Gujarat, India.Methods: This prospective observational study was conducted in the neonatal intensive care unit (NICU) and Post Natal ward Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat. Total of 150 cases were enrolled for the study. Blood grouping and Rh typing of baby and mother were done. Cord blood bilirubin and haemoglobin, direct coomb's test (DCT) and bilirubin monitoring were done whenever there was a setting for Rh incompatibility.Results: Among 150 neonates studied, majority had birth weight between 2501g and 3000g. Only 21 babies had birth weight <2.5kg (14%) (Table 2). Of the 150 neonates 85 were males and 65 were females.Conclusions: This study concludes that physiological jaundice is the most common cause of neonatal jaundice in our hospital. This is followed by ABO incompatibility, sepsis, Rh incompatibility and idiopathic cases.
Background and Aim: Neonatal Hyperbilirubinemia (NH) is the most common cause for readmission during the early neonatal period. There are reports of bilirubin induced brain damage occurred in healthy term infants even without haemolysis and the sequalae could be serious. Aim of the study was to predict the development of Neonatal Hyperbilirubinemia at birth using Cord Serum Albumin as a risk indicator. Material and Methods: Observation study was performed on 348 healthy term new-borns. Cord blood was collected from the healthy term new-borns delivered either vaginally or caesarean section for cord serum albumin level measurements. Total serum bilirubin and direct serum bilirubin were measured during 72-96 hours of life with serum sampling of peripheral venous blood. Newburn was assessed clinically daily for Neonatal Hyperbilirubinemia or for any other complication during the study period. Results: Study cohort is grouped into Group1, Group2 and Group 3 based on Cord Serum Albumin level ≤ 2.8g/dl, 2.9-3.3g/dl and ≥ 3.4g/dl, respectively. In these groups, new-borns with total serum bilirubin level ≥17mg/dl after 72 hours are taken as Neonatal Hyperbilirubinemia, requiring interventions like phototherapy or exchange transfusion. Conclusion:There is a correlation between Cord serum albumin level and neonatal hyperbilirubinemia in healthy term new-borns. Cord serum albumin level of ≤2.8 g/dl can predict the development of neonatal hyperbilirubinemia.
Background: The objective of the present study is to observe the effect of frequency of changing nasogastric feeding tube (NG-FT) on microbial growth in relation to development of neonatal sepsis in premature newborns. The study is prospective observational study in its nature. Neonatal intensive care unit (NICU) of a tertiary care teaching hospital of western Gujarat, India, from December 2016 to November 2017.Methods: Eighty-five preterm newborns admitted to NICU for feeding support were randomly divided into three groups depending on frequency of changing nasogastric feeding tubes (Group I, II and III with NG-FT changed every 12, 24 and 48 hourly respectively). In Groups I, II and III, the first NG-FT cultures were sent at the end of 12, 24, 48 hours of NG-FT insertion respectively. The second and third NG-FT cultures were sent after 7 and 14 days respectively. Microbial growth pattern was observed and correlated with development of necrotizing enterocolitis (NEC), neonatal sepsis and mortality.Results: Microbial growth on first NG-FT culture significantly increased when frequency of changing nasogastric feeding tube was reduced from every 12 to 24 or 48 hours {p = 0.0432 (Group I vs II) and 0.0001 (Group I vs III)}. Microbial growth increased on second (24.1%, 87% and 85% in groups I, II and III respectively) and third NG-FT culture (44% in group I and 100% in groups II and III); this was significantly high in group II and III as compared to group I (p = 0.0001). Common organisms isolated were Klebsiella pneumonia (63.28%), Pseudomonas aeruginosa (32%) and Escherichia coli (21%). No significant difference was noted in incidences of feeding intolerance, necrotizing enterocolitis (NEC), neonatal sepsis and mortality among the three groups.Conclusions: Organism growth in nasogastric feeding tube culture increases significantly when frequency of changing NG-FT is beyond 12 hours. However, there is no increase in episodes of feeding intolerance, necrotizing enterocolitis (NEC), neonatal sepsis and mortality.
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