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Our objective was to conduct a systematic review and meta-analysis evaluating the effects of administering positive end-expiratory pressure (PEEP) during neonatal resuscitation at birth. Medline, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov databases were systematically searched from inception to 15 December 2020. Randomized controlled trials and cohort studies were held eligible. Studies were included if they compared the administration of PEEP using either a T-piece resuscitator or a self-inflating bag with a PEEP valve versus resuscitation via a self-inflating bag without a PEEP valve. Data were extracted by two reviewers independently. The credibility of evidence was appraised with the Grading of Recommendations, Assessment, Development, and Evaluations approach. Random-effects models were fitted to provide pooled estimates of risk ratio (RR) and 95% confidence intervals (CIs). Overall, 10 studies were included, comprising 4,268 neonates. This included five randomized controlled trials, one quasi-randomized trial, and four cohort studies. The administration of PEEP was associated with significantly lower rates of mortality till discharge (odds ratio [OR]: 0.60, 95% CI: 0.49–0.74, moderate quality of evidence). The association was significant in preterm (OR: 0.57, 95% CI: 0.46–0.69) but not in term (OR: 1.03, 95% CI: 0.52–2.02) neonates. Low-to-moderate quality evidence suggests that providing PEEP during neonatal resuscitation is associated with lower rates of mortality in preterm neonates. Evidence regarding term neonates is limited and inconclusive. Future research is needed to determine the optimal device and shed more light on the long-term effects of PEEP administration during neonatal resuscitation. This study is registered with PROSPERO with registration number: CRD42020219956. Key Points PEEP administration during neonatal resuscitation in the delivery room reduces mortality in preterm. Evidence regarding term neonates is limited and inconclusive. Future research is needed to determine the optimal device. [ABSTRACT FROM AUTHOR]

Sepsis is a significant cause of mortality and morbidity in the NICU despite the potent armamentarium of antibiotics. Recently, there has been a considerable increase in antimicrobial resistance even to high-end 3rd line antibiotics. Thus, there is a need to look into adjunctive therapies. This study aims to study the role of double volume exchange transfusion (DVET) in reducing mortality due to severe sepsis. All neonates with severe sepsis admitted in NICU from January 2017 to September 2019 were included in the study. Seven neonates who met inclusion criteria and received DVET were compared to 21 gestation and severity matched controls, who received standard therapy (ST) alone. The primary outcome studied was mortality before discharge in both the groups. Other results analyzed were the incidence of persistent thrombocytopenia and refractory shock. There was a significant reduction in mortality in the intervention group (57% vs. 71% (p =.004). There was also a significant reduction both in the incidence of refractory shock (71% vs. 75%; p =.01) and persistent thrombocytopenia (86% vs. 65%; p =.03) in the DVET group. No significant adverse effects occurred following DVET. In neonates with severe sepsis, DVET may be a useful adjunct therapy. It may reduce mortality and decreased the incidence of refractory shock and thrombocytopenia. DVET is a safe procedure in severely sick and septic neonates. [ABSTRACT FROM AUTHOR]

Respiratory distress in neonatal period is of diverse etiology and require timely diagnosis and treatment for a good outcome. This study was aimed to determine the outcome of neonates having respiratory distress admitted in the NICU of a tertiary care hospital. Methods This prospective study was conducted in the neonatal intensive care unit of Dr. M R Khan Shishu Hospital & ICH, from July 2021 to June 2022. Neonates presented with signs of respiratory distress were enrolled in the study. History, examination and investigations were performed to find out various etiologies. Neonates were managed accordingly and were followed up to hospital stay. Primary outcome was measured in terms of discharge and death, and secondary outcomes were pattern of respiratory supports required. Data was analyzed using SPSS 20. Results Among 1225 admitted newborns, 720 (59%) had respiratory distress. Mean gestational age was 37.54 ± 2.1 weeks and mean birth weight was 2692.96 ± 651 g. Common causes of respiratory distress were sepsis (35.4%) and perinatal asphyxia (27%) followed by transient tachypnea of newborn (11.4%). Most of the babies required only nasal oxygen support (72%) and 15% were treated with CPAP and 8% got mechanical ventilator. Mortality rate was 2.5% and congenital pneumonia was significantly associated with neonatal death (p=0.02). Conclusion The common causesfor respiratory distress were sepsis, asphyxia, TTNB, RDS, MAS and congenital pneumonia. Congenital pneumonia was significantly associated with mortality [ABSTRACT FROM AUTHOR]