Although therapeutic hypothermia (TH) is the standard of care for hypoxic ischaemic encephalopathy in high-income countries, the safety and efficacy of this therapy in low-income and middle-income countries (LMICs) is unknown. We aimed to describe the feasibility of TH using a low-cost servo-controlled cooling device and the short-term outcomes of the cooled babies in LMIC.DesignWe recruited babies with moderate or severe hypoxic ischaemic encephalopathy (aged <6 hours) admitted to public sector tertiary neonatal units in India over a 28-month period. We administered whole-body cooling (set core temperature 33.5°C) using a servo-controlled device for 72 hours, followed by passive rewarming. We collected the data on short-term neonatal outcomes prior to hospital discharge.ResultsEighty-two babies were included—61 (74%) had moderate and 21 (26%) had severe encephalopathy. Mean (SD) hypothermia cooling induction time was 1.7 hour (1.5) and the effective cooling time 95% (0.08). The mean (SD) hypothermia induction time was 1.7 hour (1.5 hour), core temperature during cooling was 33.4°C (0.2), rewarming rate was 0.34°C (0.16°C) per hour and the effective cooling time was 95% (8%). Twenty-five (51%) babies had gastric bleeds, 6 (12%) had pulmonary bleeds and 21 (27%) had meconium on delivery. Fifteen (18%) babies died before discharge from hospital. Heart rate more than 120 bpm during cooling (P=0.01) and gastric bleeds (P<0.001) were associated with neonatal mortality.ConclusionsThe low-cost servo-controlled cooling device maintained the core temperature well within the target range. Adequately powered clinical trials are required to establish the safety and efficacy of TH in LMICs.Clinical trial registration number
NCT01760629.
Oxidative stress is increased in preeclamptic mother - newborn dyads. Increased protein carbonyl levels in preeclampsia correlate with adverse early neonatal outcome.
BackgroundUse of bubble continuous positive airway pressure (CPAP) has generated considerable interest in neonatal care, but its comparative effectiveness compared with other forms of CPAP, especially in developed countries, remains unclear.ObjectiveTo systematically review and meta-analyse short-term clinical outcomes among preterm infants treated with bubble CPAP vs all other forms of CPAP.MethodsProspective experimental studies published from 1995 onward until October 2018 comparing bubble versus other CPAP forms in preterm neonates <37 weeks’ gestational age were included after a systematic review of multiple databases using pre-specified search criteria.ResultsA total of 978 articles were identified, of which 19 articles were included in meta-analyses. Of these, 5 had a high risk of bias, 8 had unclear risk and 6 had low risk. The risk of the primary outcome (CPAP failure within 7 days) was lower with bubble CPAP (0.75; 95% CI 0.57 to 0.98; 12 studies, 1194 subjects, I2=21%). Among secondary outcomes, only nasal injury was higher with use of bubble CPAP (risk ratio (RR) 2.04, 95% CI 1.33 to 3.14; 9 studies, 983 subjects; I2=42%) whereas no differences in mortality (RR 0.82, 95% CI 0.47 to 1.92; 9 studies, 1212 subjects, I2=20%) or bronchopulmonary dysplasia (BPD) (RR 0.8, 95% CI 0.53 to 1.21; 8 studies, 816 subjects, I2=0%) were noted.ConclusionBubble CPAP may lead to lower incidence of CPAP failure compared with other CPAP forms. However, it does not appear to translate to improvement in mortality or BPD and potential for nasal injury warrants close monitoring during clinical application.Trial registration numberCRD42019120411.
A generalized endothelial dysfunction and poor birth outcomes were observed in hypertensive disorders of pregnancy. There is a spectrum of biochemical derangements related to endothelial dysfunction in GH, EOPE, LOPE and E in that order.
A population-based cross-sectional inquiry was carried out in Delhi to assess the practice of fetal sex determination, sex-selective abortions and awareness about the related law. A total of 1514 respondents, selected through multistage cluster sampling from all across Delhi, were interviewed using a pretested, semistructured questionnaire. Legal awareness (73.6%) was significantly better among the male and urban respondents. Only 39 (2.6%) of the respondents had ever gone for fetal sex determination. In 17 (43.6%) of them, it was done in spite of being aware of its unlawfulness, and in 33 (84.6%), the couple had one or more living male children. Frequency of fetal sex determination was comparable for slum and urban areas. Fifty-six additional cases of fetal sex determination, occurring in the neighbourhood of the respondents, were also reported. A total of 28 cases of female feticide were reported. Awareness about the illegality of fetal sex determination has improved, compared with the 1997-1998 data collected from East Delhi (55.3-73.6%). However, this comparison also shows a marginal increase in the practice of fetal sex determination (2.1-2.6%). In all cases of feticide, a qualified doctor was involved. A number of couples abandoned the abortion plan midway, even after detecting that the fetus was female, and there were occasional cases where the doctor refused to abort the female fetus.
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