Objective To compare postductal heart rate and saturation (SpO 2 ) measurements from the wireless PO device obtained by iVital+ against measurements by the standard Masimo (SET technology) monitor in the monitoring of neonates. Methods Pulse oximetry reading of newborns were assessed in terms of heart rate and saturations with two PO simultaneously attached to postductal site and data comparison was done. Results Out of the 1000 cumulative recordings, the mean difference between HR obtained from both PO was 0.415 and level of agreement was 2.3 beats per minute. For SpO 2 mean difference between devices was 1.21 and level of agreement was 1.5%. There was very little difference between SpO 2 measurements when the Masimo SpO 2 was ≥ 70%. Conclusion As this pulse oximeter is small, portable and accuracy is as comparable to Masimo, this provides a good solution for efficaciously monitoring neonates. It can also be used in the monitoring of children with suspected or affected with COVID-19 in hospital and ICU settings as also in the quarantine facilities. This reduces the need for constant presence of medical and nursing personnel.
Globally, newborn health is now considered as high-level national priority. The current neonatal and infant mortality rate in India is 29 per 1000 live births and 42 per 1000 live births, respectively. The last decade has seen a tremendous growth of neonatal intensive care in India. The proliferation of neonatal intensive care units, as also the infusion of newer technologies with availability of well-trained medical and nursing manpower, has led to good survival and intact outcomes. There is good care available for neonates whose parents can afford the high-end healthcare, but unfortunately, there is a deep divide and the poor rural population is still underserved with lack of even basic newborn care in few areas! There is increasing disparity where the 'well to do' and the 'increasingly affordable middle class' is able to get the most advanced care for their sick neonates. The underserved urban poor and those in rural areas still contribute to the overall high neonatal morbidity and mortality in India. The recent government initiative, the India Newborn Action Plan, is the step in the right direction to bridge this gap. A strong public-private partnership and prioritisation is needed to achieve this goal. This review highlights the current situation of neonatal intensive care in India with a suggested plan for the way forward to achieve better neonatal care.
BackgroundRetinopathy of prematurity (ROP) and abnormal brain development share similar risk factors and mechanisms. There has been contrasting evidence on the association of ROP with adverse neurodevelopmental outcomes.ObjectiveWe analysed the association between ROP at levels of severity and treatment with all neurodevelopmental outcomes until adolescence.Data sourceWe followed PRISMA guidelines and searched Medline and Embase between 1 August 1990 and 31 March 2022.Study selection and participantsRandomised or quasi-randomised clinical trials and observational studies on preterm infants (<37 weeks) with ROP [type 1 or severe ROP, type 2 or milder ROP, laser or anti-vascular endothelial growth factor (VEGF) treated] were included.Data extraction and synthesisWe included studies on ROP and any neurocognitive or neuropsychiatric outcomes.OutcomesThe primary outcomes were as follows: cognitive composite scores evaluated between the ages of 18 and 48 months by the Bayley Scales of Infant and Toddler Development (BSID) or equivalent; neurodevelopmental impairment (NDI; moderate to severe NDI or severe NDI), cerebral palsy, cognitive impairment; and neuropsychiatric or behavioural problems. The secondary outcomes were as follows: motor and language composite scores evaluated between the ages of 18 and 48 months by BSID or equivalent; motor/language impairment; and moderate/severe NDI as defined by the authors.ResultsIn preterm infants, “any ROP” was associated with an increased risk of cognitive impairment or intellectual disability [n = 83,506; odds ratio (OR): 2.56; 95% CI: 1.40–4.69; p = 0.002], cerebral palsy (n = 3,706; OR: 2.26; 95% CI: 1.72–2.96; p < 0.001), behavioural problems (n = 81,439; OR: 2.45; 95% CI: 1.03–5.83; p = 0.04), or NDI as defined by authors (n = 1,930; OR: 3.83; 95% CI: 1.61–9.12; p = 0.002). Type 1 or severe ROP increased the risk of cerebral palsy (OR: 2.19; 95% CI: 1.23–3.88; p = 0.07), cognitive impairment or intellectual disability (n = 5,167; OR: 3.56; 95% CI: 2.6–4.86; p < 0.001), and behavioural problems (n = 5,500; OR: 2.76; 95% CI: 2.11–3.60; p < 0.001) more than type 2 ROP at 18–24 months. Infants treated with anti-VEGF had higher odds of moderate cognitive impairment than the laser surgery group if adjusted data (gestational age, sex severe intraventricular haemorrhage, bronchopulmonary dysplasia, sepsis, surgical necrotising enterocolitis, and maternal education) were analysed [adjusted OR (aOR): 1.93; 95% CI: 1.23–3.03; p = 0.04], but not for cerebral palsy (aOR: 1.29; 95% CI: 0.65–2.56; p = 0.45). All outcomes were adjudged with a “very low” certainty of evidence.Conclusion and relevanceInfants with “any ROP” had higher risks of cognitive impairment or intellectual disability, cerebral palsy, and behavioural problems. Anti-VEGF treatment increased the risk of moderate cognitive impairment. These results support the association of ROP and anti-VEGF treatment with adverse neurodevelopmental outcomes.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42022326009.
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