Objectives: World Health Organization recommends exclusive breastfeeding (EBF) for 6 months after birth. However, problems with the baby failing to latch properly are common in the postpartum period contributing to breastfeeding cessation. The aim of the study was to evaluate the utility of LATCH score to predict EBF and weight gain at 6 weeks postpartum along with an optimum LATCH score cutoff. Patients and Methods: This prospective cohort study was conducted in India. Ninety-three mother-infant dyads at term gestation were enrolled. Two LATCH score assessments were done by a lactation consultant: first within 24 hours of birth and second at discharge. Mothers with low LATCH scores were counselled before discharge. EBF rate and weight gain velocity were analyzed at 6 weeks. Results: LATCH score ≥6 at discharge has the highest sensitivity (92.1%) and specificity (66.7%) for predicting EBF at 6 weeks postpartum (RR, 95% CI; 5.63 [4.32–12.65], P = 0.0003). Receiver operating characteristic (ROC) of LATCH score at discharge and EBF at 6 weeks had an area under the curve of 0.785 with a cutoff ≥5.5, showing the highest sensitivity of 93.6% with a false-positive rate of 30.1%. LATCH score >6 at discharge was significantly associated with higher EBF rate (RR, 95% CI; 0.61 [0.39–0.94]) and appropriate weight gain (≥ 20 grams/day) at 6 weeks of age (RR, 95% CI; 0.44 [0.25–0.75]). After counselling, the LATCH score significantly improved at discharge in mothers (n = 62) with an initial score <6 (P < 0.001). Conclusion: LATCH score is a simple tool to identify mothers who require breastfeeding support and counselling before discharge from the hospital to prevent early breastfeeding cessation.

Background: Thrombocytopenia as a side effect of phototherapy has not been mentioned in the standard literature but was described briefly as isolated case reports after the phototherapy came in vogue in 1958. The purpose of this study was to find the incidence of thrombocytopenia in neonates with uncomplicated indirect hyperbilirubinemia receiving phototherapy in a referral hospital.Methods: This was a prospective cohort study conducted in a referral hospital over a period of 18 months from June 1, 2013 to November 1, 2014.Results: A total of 103 babies were enrolled. The overall incidence of post-phototherapy thrombocytopenia was 45.6% while mild, moderate and severe thrombocytopenia was present in 66%, 21.3% and 12.8% of babies respectively. The lowest platelet count observed was 31,000/mm3 but none of the neonates showed bleeding manifestations. The incidence of thrombocytopenia following phototherapy was significantly higher in preterm babies, infants who received double surface phototherapy, babies who received phototherapy for >72 hours and in babies who received phototherapy on day 2 or 3 of life.Conclusions: Neonates requiring phototherapy for hyperbilirubinemia are at risk of developing thrombocytopenia, hence the treatment should be initiated based on the standard guidelines. Unnecessary use and prolongation of phototherapy should be avoided considering the possible side effects. Platelet count should be monitored particularly in pre-term neonates receiving phototherapy. Neonates receiving double surface phototherapy and those requiring phototherapy for longer duration require more frequent platelet count monitoring.

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Background: Objective of the study was to determine the incidence and risk factors for extrauterine growth restriction (EUGR) at discharge in preterm neonates.Methods: This prospective analytical cohort study included 107 preterm neonates between 30-35 weeks of gestational age who were admitted to a tertiary neonatal intensive care unit from January 2016 to December 2016. These preterm neonates were classified into EUGR group (n=93) and non-EUGR group (n=14) based on the body weight at discharge. The risk factors for EUGR were analyzed statistically.Results: The incidence of EUGR at discharge was 87.4% in the cohort. Delay in initiation of parenteral nutrition (p=0.04), longer time to reach full enteral feeds (p=0.03), very low birth weight (p=0.01), small for gestational age (p=0.01), intrauterine growth restriction (p=0.01), necrotizing enterocolitis (p=0.03), late-onset sepsis (p=0.03) and bronchopulmonary dysplasia (p=0.04) were significant risk factors for extra-uterine growth restriction at discharge in preterm neonates.Conclusions: The incidence of EUGR can be decreased by improving perinatal care, minimizing preterm deliveries, early initiation of parenteral nutrition and enteral feeding and reducing immediate postnatal complications.

Background:Despite changes in nutritional interventions in neonatal intensive care units worldwide, significant proportion of preterm babies are growth restricted at discharge. Authors intended to look at the feasibility of aggressive nutrition bundle (aggressive parenteral nutrition, standardized feeding policy, fortification and probiotics) in preterm neonates. Methods: This single centre prospective analytical cohort study, involving babies born before 34 weeks of gestation, was conducted in a tertiary hospital. Aggressive parenteral nutrition and enteral nutrition bundle intervention was started within 24 hours of birth. Clinical, laboratory and anthropometrical parameters were monitored longitudinally to ensure safety of this intervention. Results: Mean gestational age and birth weight of the cohort (n=107) was 30.6 weeks (SD±2.6) and 1147 grams (SD±287) respectively. Out of 107 babies, 67.3% (n=72) have extra uterine growth retardation (EUGR) at discharge and was more in small for gestational age neonates (p=0.001). With this aggressive parenteral and enteral nutrition bundle intervention, medical necrotizing enterocolitis (NEC) developed in 7.4 % (n=8) babies while surgical NEC was seen in 1.9%. (n=2). Early onset and late-onset sepsis occurred in 1.8% and 5.4% of babies respectively while mild hyperammonemia, mild hypertriglyceridemia, raised creatinine and urea developed in 12.4%, 4.6%, 7.4% and 11.7% respectively. Hyperglycemia and hypoglycemia were present in 8.8% and 5.6% babies respectively. Conclusions: Aggressive nutrition bundle (aggressive parenteral nutrition, standardized feeding policy, fortification and probiotics) can be safely employed in preterm babies. There is an urgent need to design a study to see the impact of this approach on incidence of EUGR in preterm babies.

Background: Recently published studies have suggested that inhaled corticosteroids may offer benefit over systemic steroids in bronchial asthma. This research was carried out to study the efficacy of inhaled budesonide and to compare the efficacy of inhaled budesonide with oral prednisolone in the treatment of acute moderate asthma in children.Methods: This was an open label randomized clinical trial. Children in the age group of 1-12 years with acute exacerbation of asthma presenting to pediatric emergency from November 1, 2015 to October 31, 2016 who fail to show prompt improvement after initial treatment with oxygenand three doses of inhaled salbutamol, were enrolled. Children in group B (n=35) and group P (n=35) received inhaled budesonide and oral prednisolone, respectively, in addition to oxygen inhalation and salbutamol as per the study protocol. Outcome was measured in terms of pulmonary score at the beginning, at 6 hours, and at 24 hours of starting the treatment. The analysis was undertaken according to intent to treat principle.Results: Baseline characteristics (sex, age, weight, height, body mass index) were comparable in the 2 groups. Mean heart rate, respiratory rate, pulmonary score at 6 and 24 hours, mean SpO2 at 24 hours were significantly showing normalizing trend (p<0.05) and mean hospital stay was significantly reduced [2.60 (±0.60) vs 3.11 (±0.80); p<0.05] in group B as compared to group P.Conclusions: Outcome measures of clinical improvement were better in inhaled budesonide group than oral prednisolone group in acute moderate exacerbation of bronchial asthma.

Background: Improvement in neonatal health care services has led to the survival of extreme low birth weight babies over the years. This has led to increased number of retinopathy of prematurity (ROP) cases being diagnosed. Thus it becomes imperative to identify factors which can reliably predict preterm neonates at increased risk of ROP. Aims and objectives were to identify red cell indices at 4 weeks postpartum which can predict ROP in extreme low birth weight neonates.Methods: Three years ROP data in extremely low birth weight neonates was retrospectively collected and analyzed.Results: The mean gestational age at birth of the neonates in ROP group (n=149) and no-ROP group (n=191) was 28.25 (±2.71) weeks and 31.82 (±2.24) weeks, respectively (p<0.05). The mean birth weight of the neonates in ROP group and no-ROP group was 756.44 (±95.50) grams and 890 (±109.20) grams, respectively (p<0.05). In extremely low birth weight (ELBW) neonates, hematologic parameters such as hemoglobin, hematocrit, red blood cells, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration values were lower and white blood cell count was higher in ROP group as compared to no-ROP group (p<0.05).Conclusions: Red cell indices may predict which extreme low birth weight neonates are at increased risk of developing retinopathy of prematurity. Being easily and widely available, red cell indices can be used as a screening test to predict ROP.

Background: Despite advances in understanding of pathophysiological changes in neonatal shock, its effect on morbidity and mortality is still an ongoing process. The primary objective was to study etiology-specific mortality and the secondary objective was to study the short-term morbidities of neonatal shock in premature babies born less than 34 weeks of gestation.Methods: This single centre prospective cohort study was conducted from 01 January 2017 to 31 March 2018. Neonatal shock was defined on clinical and laboratory criteria. Outcomes in terms of mortality and short-term morbidities like intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), acute kidney injury (AKI), chronic lung disease (CLD) and retinopathy of prematurity (ROP) were recorded for analysis.Results: A total of 119 preterm neonates with shock were enrolled. The most common etiology of neonatal shock was late-onset-sepsis (LOS: 34.4%; n=41) followed by transient circulatory compromise (22.6%; n=27) and early-onset-sepsis (EOS: 14.2%, n=17). The overall mortality of neonatal shock was 15.9% (n=19) out of which 36.8% (n=7) had EOS, 26.3% (n=5) had myocardial dysfunction and 21% (n=4) had LOS (p<0.05). On logistic regression, none of the independent variables were significant for mortality. Neonatal morbidities of IVH (> Grade 2), NEC, CLD, AKI and ROP developed in 4.2% (n=5), 11.7% (n=14), 15% (n=18), 27.7% (n=33) and 33. 6% (n=40) respectively.Conclusions: LOS was the commonest etiology of neonatal shock in preterm neonates. Neonatal shock due to EOS was the major cause of mortality in preterm neonates thus highlighting the need for preventing EOS to improve survival and to reduce neonatal morbidities.