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1. ELBW and ELGAN outcomes in developing nations–Systematic review and meta-analysis

Author

Viraraghavan Vadakkencherry Ramaswamy, Thangaraj Abiramalatha, Tapas Bandyopadhyay, Nasreen Banu Shaik, Prathik Bandiya, Debasish Nanda, Abdul Kareem Pullattayil S., Srinivas Murki, and Charles Christoph Roehr

Subjects
Medicine, Science
Abstract

Context Morbidity and mortality amongst extremely low birth weight (ELBW) and extremely low gestational age neonates (ELGANs) in developing nations has not been well studied. Objectives Evaluate survival until discharge, short- and long-term morbidities of ELBW and ELGANs in LMICs. Data sources CENTRAL, EMBASE, MEDLINE and Web of Science. Study selection Prospective and retrospective observational studies were included. Data extraction and synthesis Four authors extracted data independently. Random-effects meta-analysis of proportions was used to synthesize data, modified QUIPS scale to evaluate quality of studies and GRADE approach to ascertain the certainty of evidence (CoE). Results 192 studies enrolling 22,278 ELBW and 18,338 ELGANs were included. Survival was 34% (95% CI: 31% - 37%) (CoE–low) for ELBW and 39% (34% - 44%) (CoE—moderate) for ELGANs. For ELBW neonates, the survival for low-income (LI), lower middle-income (LMI) and upper middle income (UMI) countries was 18% (11% - 28%), 28% (21% - 35%) and 39% (36% - 42%), respectively. For ELGANs, it was 13% (8% - 20%) for LI, 28% (21% - 36%) for LMI and 48% (42% - 53%) for UMI countries. There was no difference in survival between two epochs: 2000–2009 and 2010–2020. Except for necrotising enterocolitis [ELBW and ELGANs—8% (7% - 10%)] and periventricular leukomalacia [ELBW—7% (4% - 11%); ELGANs—6% (5%-7%)], rates of all other morbidities were higher compared to developed nations. Rates of neurodevelopmental impairment was 17% (7% - 34%) in ELBW neonates and 29% (23% - 37%) in ELGANs. Limitations CoE was very low to low for all secondary outcomes. Conclusions Mortality and morbidity amongst ELBW and ELGANs is still a significant burden in LMICs. CoE was very low to low for all the secondary outcomes, emphasizing the need for high quality prospective cohort studies. Trial registration PROSPERO (CRD42020222873).

Published
2021

2. Quantification of gaze reaction time in infants with Pediatric Perimeter.

Author

Sourav Datta, Koteswararao Chilakala, Sandeep Vempati, Tejopratap Oleti, Jaishree Kulkarni, Srinivas Murki, Pramod Gaddam, and PremNandhini Satgunam

Subjects
Medicine, Science
Abstract

PurposeWe quantified the eye/head (gaze) reaction time in infants to establish a normative database for the Pediatric Perimeter device. Additionally, we tested the hypothesis that gaze reaction time will reduce with age.MethodsA cross-sectional study was conducted. Healthy infants between 3 to 10 months of age were recruited. Peripheral visual field stimuli (hemifield and quadrant stimuli) were presented in the Pediatric Perimeter device. Infant's gaze to these stimuli was observed, documented in real time, and video recorded for offline analysis.ResultsA total of 121 infants were tested in three age group bins [3-5 months, n = 44; >5-7 months, n = 30 and >7-10 months, n = 47]. Overall, 3-5 months old had longer reaction time when compared to the older infants particularly for stimuli presented in the quadrants (Kruskal-Wallis, pConclusionThis study provides the normative gaze reaction time of healthy infants. With increase in age, there is reduction in reaction time and disappearance of reaction time asymmetry in quadrant stimuli. The longer reaction time for upward gaze could be due to delayed maturation of neural mechanisms and/or decreased visual attention.

Published
2021
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3. 'Nasal mask' in comparison with 'nasal prongs' or 'rotation of nasal mask with nasal prongs' reduce the incidence of nasal injury in preterm neonates supported on nasal continuous positive airway pressure (nCPAP): A randomized controlled trial.

Author

Tanveer Bashir, Srinivas Murki, Sai Kiran, Venkat Kallem Reddy, and Tejo Pratap Oleti

Subjects
Medicine, Science
Abstract

BACKGROUND:With increasing use of nCPAP, the safety and comfort associated with nCPAP have come into the forefront. The reported incidence of nasal injuries associated with the use of nCPAP is 20% to 60%. A recent meta-analysis concluded that the use of nasal masks significantly decreases CPAP failure and the incidence of moderate to severe nasal injury and stress the need for a well powered RCT to confirm their findings. METHODS:In this Open label, 3 arms, sequential, stratified randomized controlled trial, we evaluated the incidence and severity of nasal injury at removal of nCPAP when using two different nasal interfaces and in three groups (i.e. rotation group, mask continue group, prong continue group). Preterm infants with gestation ≤ 30 weeks and respiratory distress within the first 6 hours of birth and in need of CPAP were eligible for the study. RESULTS:Among the 175 newborns included in the study, incidence of nasal injury in mask continue group [n = 19/57 (33.3%)] was significantly less as compared to prong continue group [n = 55/60 (91.6%)] and rotation group [33/ 58 (56.9%), p value

Published
2019
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4. ELBW and ELGAN outcomes in developing nations–Systematic review and meta-analysis

Author

Charles Christoph Roehr, Nasreen Banu Shaik, Viraraghavan Vadakkencherry Ramaswamy, Thangaraj Abiramalatha, Srinivas Murki, Prathik Bandiya, S Abdul Kareem Pullattayil, Debasish Nanda, and Tapas Bandyopadhyay

Subjects
Male, Pediatrics, Economics, Epidemiology, Maternal Health, Social Sciences, Economic Geography, Neonatal Care, Geographical Locations, Mathematical and Statistical Techniques, Infant Mortality, Medicine and Health Sciences, Medicine, Prospective cohort study, Multidisciplinary, Geography, Statistics, Gestational age, Metaanalysis, Research Assessment, Observational Studies as Topic, Infant, Extremely Low Birth Weight, Meta-analysis, Physical Sciences, Low and Middle Income Countries, Female, medicine.symptom, Infant, Premature, Research Article, China, medicine.medical_specialty, Asia, Systematic Reviews, Science, Developing country, Gestational Age, Context (language use), Research and Analysis Methods, Humans, Statistical Methods, Developing Countries, Periventricular leukomalacia, business.industry, Infant, Newborn, Infant, Biology and Life Sciences, Neonates, Middle income, medicine.disease, Survival Analysis, Health Care, Low birth weight, Medical Risk Factors, People and Places, Earth Sciences, Women's Health, Neonatology, Health Statistics, Morbidity, business, Mathematics, Developmental Biology
Abstract

Context Morbidity and mortality amongst extremely low birth weight (ELBW) and extremely low gestational age neonates (ELGANs) in developing nations has not been well studied. Objectives Evaluate survival until discharge, short- and long-term morbidities of ELBW and ELGANs in LMICs. Data sources CENTRAL, EMBASE, MEDLINE and Web of Science. Study selection Prospective and retrospective observational studies were included. Data extraction and synthesis Four authors extracted data independently. Random-effects meta-analysis of proportions was used to synthesize data, modified QUIPS scale to evaluate quality of studies and GRADE approach to ascertain the certainty of evidence (CoE). Results 192 studies enrolling 22,278 ELBW and 18,338 ELGANs were included. Survival was 34% (95% CI: 31% - 37%) (CoE–low) for ELBW and 39% (34% - 44%) (CoE—moderate) for ELGANs. For ELBW neonates, the survival for low-income (LI), lower middle-income (LMI) and upper middle income (UMI) countries was 18% (11% - 28%), 28% (21% - 35%) and 39% (36% - 42%), respectively. For ELGANs, it was 13% (8% - 20%) for LI, 28% (21% - 36%) for LMI and 48% (42% - 53%) for UMI countries. There was no difference in survival between two epochs: 2000–2009 and 2010–2020. Except for necrotising enterocolitis [ELBW and ELGANs—8% (7% - 10%)] and periventricular leukomalacia [ELBW—7% (4% - 11%); ELGANs—6% (5%-7%)], rates of all other morbidities were higher compared to developed nations. Rates of neurodevelopmental impairment was 17% (7% - 34%) in ELBW neonates and 29% (23% - 37%) in ELGANs. Limitations CoE was very low to low for all secondary outcomes. Conclusions Mortality and morbidity amongst ELBW and ELGANs is still a significant burden in LMICs. CoE was very low to low for all the secondary outcomes, emphasizing the need for high quality prospective cohort studies. Trial registration PROSPERO (CRD42020222873).

Published
2021
Full Text
View/download PDF

5. 'Nasal mask' in comparison with 'nasal prongs' or 'rotation of nasal mask with nasal prongs' reduce the incidence of nasal injury in preterm neonates supported on nasal continuous positive airway pressure (nCPAP): A randomized controlled trial

Author

Srinivas Murki, Venkat Kallem Reddy, Sai Kiran, Tejo Pratap Oleti, and Tanveer Bashir

Subjects
Male, Physiology, medicine.medical_treatment, law.invention, Families, Mathematical and Statistical Techniques, 0302 clinical medicine, Randomized controlled trial, law, Medicine and Health Sciences, Birth Weight, Medicine, 030212 general & internal medicine, Continuous positive airway pressure, Children, Nose, Multidisciplinary, Continuous Positive Airway Pressure, Respiratory distress, Incidence, Incidence (epidemiology), Statistics, Masks, Metaanalysis, Chemistry, Nasal injury, medicine.anatomical_structure, Physiological Parameters, Anesthesia, Physical Sciences, Gestation, Female, Anatomy, Infants, Infant, Premature, Research Article, Chemical Elements, Adult, Soft Tissue Injuries, Drug Research and Development, Birth weight, Science, India, Research and Analysis Methods, 03 medical and health sciences, 030225 pediatrics, Humans, Clinical Trials, Statistical Methods, Pharmacology, Respiratory Distress Syndrome, Newborn, Analysis of Variance, business.industry, Body Weight, Infant, Newborn, Biology and Life Sciences, Neonates, Randomized Controlled Trials, Oxygen, Age Groups, Face, People and Places, Population Groupings, Clinical Medicine, business, Head, Mathematics, Developmental Biology
Abstract

Background With increasing use of nCPAP, the safety and comfort associated with nCPAP have come into the forefront. The reported incidence of nasal injuries associated with the use of nCPAP is 20% to 60%. A recent meta-analysis concluded that the use of nasal masks significantly decreases CPAP failure and the incidence of moderate to severe nasal injury and stress the need for a well powered RCT to confirm their findings. Methods In this Open label, 3 arms, sequential, stratified randomized controlled trial, we evaluated the incidence and severity of nasal injury at removal of nCPAP when using two different nasal interfaces and in three groups (i.e. rotation group, mask continue group, prong continue group). Preterm infants with gestation ≤ 30 weeks and respiratory distress within the first 6 hours of birth and in need of CPAP were eligible for the study. Results Among the 175 newborns included in the study, incidence of nasal injury in mask continue group [n = 19/57 (33.3%)] was significantly less as compared to prong continue group [n = 55/60 (91.6%)] and rotation group [33/ 58 (56.9%), p value

Published
2019

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