Nasal continuous positive airway pressure (nCPAP) is the standard non-invasive respiratory support for newborns with respiratory distress. Nasal injury is a common problem with the interfaces used. To compare the incidence and severity of nasal injury in neonates with respiratory distress and supported on nCPAP with Hudson prong or RAM cannula with Cannulaide, a semipermeable membrane. This is an open-label, parallel-arm, gestational age-stratified, bi-centric, randomized control trial including neonates between 28 and 34 weeks gestational age and birth weight > 1000 g needing nCPAP. The size of the interface was chosen as per the manufacturer’s recommendation. Of the 229 neonates enrolled, 112 were randomized to RAM cannula with Cannulaide and 117 to Hudson prong. The baseline characteristics were similar. Any nasal injury at CPAP removal was significantly lower in the RAM cannula with Cannulaide group [6 (5.4%) vs. 31 (26.4%); risk ratio—0.77 (95% CI 0.69–0.87); p = 0.0001]. The incidence of moderate to severe nasal injury, need for mechanical ventilation within 72 h of age, duration of oxygen, and requirement of nCPAP for > 3 days were similar. For preterm infants on nCPAP, RAM cannula with Cannulaide, compared to Hudson prongs, decreases nasal injury without increasing the need for mechanical ventilation.Trail registration: CTRI/2019/03/018333, http://www.ctri.nic.in.
Background: Kangaroo mother care is an evidence-based, low cost and high impact approach that has shown significant reduction in preterm mortality. Practising KMC in COVID 19 era, is a challenge for mothers and the NICU’s. Aim of the study was to assess the effect of this pandemic on the practice of KMC in our NICU and opine about the possible barriers.Methods: It was a retrospective observational cohort study. Data was collected from the NICU records. Neonates fulfilling the inclusion criteria were classified as pre COVID-19 epoch (January 2020 to March 2020) and post COVID-19 epoch (April 2020 to June 2020). KMC hours provided were compared between the two groups.Results: Forty-six neonates were included in epoch 1 and Forty-two in epoch 2. Outcomes were analysed between the groups for primary measures, cumulative KMC hours reduced significantly in after COVID-19 period compared to the other group (median of 2 hours v/s 17 hours respectively), p value<0.001. Similarly, time to introduce first feeds increased from 6 hours in epoch 1 to 12 hours in epoch 2, p value=0.004.Conclusions: COVID-19 pandemic has affected the duration of KMC inside the NICU. Lack of clear guidelines/training about continuing KMC in COVID times has further lead to decrease in KMC duration as reported in the present study. Training and awareness regarding the benefits of KMC which outweigh its possible risks and proper sanitization and hand hygiene for both healthcare providers and KMC providers need to be enforced to continue this good practice in the NICU’s and the community.
Background: Enteral feeding in preterm neonates with intrauterine growth restriction (IUGR) and absent or reversed end diastolic flow (AREDF) on umbilical artery (UA) Doppler is delayed owing to an increased risk of necrotizing enterocolitis (NEC). Delaying enteral feeding with longer duration of parenteral nutrition (PN) carries an increased risk of various neonatal morbidities.Methods: It was a prospective observational non randomized cohort study. Data was collected prospectively from the NICU records. Neonates fulfilling the inclusion criteria were classified as early feeding regimen and late feeding regimen. A strict feeding regimen was followed. Data was analyzed for primary and secondary outcomes.Results: The 50 neonates were enrolled. Baseline characteristics were comparable. A significantly higher time to full feeds was recorded in the delayed feeding regimen by a mean of 3.9 days. The duration of hospital stay was significantly higher for delayed feeding regimen (+12.7 days). Days of mechanical ventilation were also significantly higher (+1.6 days) in the neonates in delayed feeding group. There was no difference in the incidence of feed intolerance, NEC, incidence of culture positive sepsis and mortality across the two regimens, however neonates in the delayed feeding group needed longer support with parenteral nutrition.Conclusions: Early feeding will lead to earlier time to full feeds and decreased duration of hospital stay without additional increase the incidence of feeding intolerance and NEC in neonates with AEDF/REDF. Individualized feeding strategy in these compromised neonates should be the primary objective to optimize outcomes.
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