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Objective: We evaluated ductal closure rates in preterm neonates with hemodynamically significant patent ductus arteriosus (hsPDA) who received paracetamol (PCM) as first-line therapy. Methods: In this retrospective chart review, we included inborn preterm (< 37 weeks) neonates (January 2017–December 2021) with hsPDA (ductal diameter > 1.5 mm and left atrium-to-aortic root ratio (La/Ao > 1.4) who were treated with oral or intravenous PCM. Primary outcome was hsPDA closure (defined as small or no PDA) following 3-day treatment. Secondary outcomes were need for retreatment and surgical ligation, pulmonary hypertension (PH), and in-hospital morbidities. Results: Out of 2784 preterm births, 117 neonates were diagnosed with hsPDA. Out of 96 neonates who received PCM in the first course, 20 died before the completing the first course. The median (IQR) gestation and birth weight of neonates who received PCM were 28 (26, 29) weeks and 841 (714, 1039) g, respectively. Out of 76 neonates who completed treatment with first course of PCM (57 intravenous, 19 oral), 43 (56.6%) achieved successful closure and five (6.6%) developed PH. 14 neonates received a second course of PCM; 10 achieved closure of hsPDA while one expired. Conclusion: Paracetamol is associated with successful closure of hsPDA in 56.6% of preterm neonates after one course and 70% of preemies after two courses [ABSTRACT FROM AUTHOR]

Delayed cord clamping (DCC) is an established practice in perinatology with multiple benefits. However, in instances where the implementation of DCC is not viable, it needs alternatives, especially during caesarean deliveries. A non-inferiority randomized, non-blinded, trial was conducted at a tertiary care referral unit in South India among the preterm newborns (28–36 weeks) randomized to DCC as opposed to intact-umbilical cord milking (UCM). The primary objective was to compare the mean haemoglobin values between the two groups, and the secondary outcome was to compare death and/or major IVH (> Grade II). Of the 132 eligible newborn infants, 99 were randomized to two study groups. Of the 59 and 40 randomised to UCM and DCC, 54 and 36 received the allocated intervention respectively. Preterm infants who underwent UCM had significantly higher haemoglobin (19.97 ± 1.44) as compared to DCC group (18.62 ± 0.98) p-0.0001. The rates of mortality and/or major IVH were comparable between the two groups. Conclusion: UCM may be a feasible alternative to DCC especially in settings where the latter is not achievable, without increasing the risk of adverse effects to the preterm infants, this finding needing further confirmation with larger sample. Trial registration: CTRI (Clinical Trial Registry—India) registration number: CTRI/2020/04/024566 (registered prospectively on 13/04/2020). What is Known: • Delayed cord clamping (DCC) is recommended as a standard of care for all the stable term and preterm newborn babies at birth. What is New: • Intact umbilical cord milking may be a reasonable choice of cord management when DCC is unsuccessful, without increasing adverse effects for the new born. [ABSTRACT FROM AUTHOR]

Background: India accounts for 30 percent of the neonatal deaths globally. The causes of neonatal deaths in India are infections(33%) such as pneumonia, septicemia and umbilical cord infection; prematurity(35%) and asphyxia(20%) (2). AIM: To study major causes of morbidity and mortality among neonates in Special Newborn Care Unit of a Tertiary care Hospital in Peripheral hilly region of North India. Results: A total of 1170 neonates were admitted in the SNCU over one year study period. 34.01% of these were out born babies. Male-female ratio was 1.7:1. 19.57% neonates were of Low Birth Weight, 2.48% were Very Low birth weight and 0.34% babies were Extremely Low birth weight. 10.6% babies were Late Preterm and 4.27% were preterm<34wks. Majority 30.68% of neonates were admitted for jaundice, 27.44% had sepsis, 21.28% had respiratory distress, 7.35% Birth asphyxia and 4.02% newborn babies had Meconium aspiration syndrome. 78.5% of all admitted neonates were discharged successfully.19.06% required referral to higher centre for further care, 2.22% neonates died and 0.68% Left against medical advice. In this retrospective study, 38.46% of the died neonates were Preterm (<37wks) and 42.31% had Low Birth weight (<2.5kg). CONCLUSION Neonatal jaundice, Sepsis, Respiratory distress and Birth asphyxia are major cause of hospitalization where as Prematurity, Respiratory distress syndrome and birth asphyxia are the leading cause of mortality in our study. The proportionate mortality is higher in outborn than the inborn. There is more need to promote institutional deliveries, improve antenatal and Post natal care services in this peripheral region to further bring down neonatal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Despite recent advances in obstetrics, perinatal, and neonatal care, multiple pregnancies continue to be among the riskiest conditions for the mother, fetus, and neonate. Compared to singletons, twin pregnancies have higher rates of obstetric and perinatal complications. The objective of present study was to compare the neonatal outcome of the first twin with that of the second twin delivered by vaginal route. Methods: The present study was prospective observational study. A total of 90 women with twin pregnancies more than 28 weeks of gestation were included in the study. Study was conducted from July2021toJune2022 in the Department of Pediatric and Gynae& Obstetrics, Burdwan Medical College, Burdwan, West Bengal, India. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results: The age of the mothers ranged from 18-36 years with the mean age being 24.7±3,86 years. The incidence of twin deliveries was highest among 25-30 years Mean weight of 1st twin was 2.02 kg ± 0.420 kg and mean weight of 2nd twin was 2.0 kg ± 0.430 kg. Most women delivered twins vaginally, 72.22% (n=65) for first twin and 63.33% (n=57) for the second twin. Preterm labour was the most common complication constituting 71.11% followed by anaemia, hypertensive disorders. RDS is the most common neonatal morbidityconstituting 14.44%. for the first twin and 15.56% of the second twins which resulted in the need for ventilation. The mean 1 minute APGAR scorewas 7.46±1.67 for the first twin and 6.24±1.65 for the second twin. The comparison of 1 minute APGAR. score between first and the second twin was found to be statistically significant. Conclusion: It was observed in the study that the neonatal mortality and morbidity is encountered with preterm twin delivery, so its prevention, diagnosis and treatment are must. [ABSTRACT FROM AUTHOR]

Background: India shares a huge burden of the total number of global neonatal deaths. The neonatal mortality rate in Uttarakhand is higher in comparison to the national rate. Understanding the causes and contextual factors that contribute to neonatal deaths is critical for developing a health programme and policy. Therefore, this study was aimed to ascertain causes of neonatal deaths using verbal autopsy in Rishikesh, Uttarakhand. Material and Methods: A community-based cross-sectional study was conducted in Rishikesh, Uttarakhand from July 2018 to June 2019. The study participants were mothers or primary caregivers of deceased neonates. The verbal autopsy tool of the National Health Mission, Government of India was used to collect data. All neonatal deaths from July 2018 to June 2019 were included in this study. The cause of neonatal death was ascertained by two independent doctors. Results: A total of 23 neonatal deaths could be traced during July 2018 through June 2019 in Rishikesh. One death was excluded from the study. Sixty-eight percent (15/22) of neonatal deaths occurred in the first week of life. Major causes of neonatal deaths were perinatal asphyxia (7/22), congenital malformation (6/22), and prematurity (4/22). Most (9/22) of the delays were in making a decision to seek medical care for neonates. Conclusion: The major causes of neonatal deaths were perinatal asphyxia, congenital malformation, and prematurity. Most of the deaths occurred during the early neonatal period. [ABSTRACT FROM AUTHOR]

Introduction: Congenital Anomalies (CA) are a significant cause of neonatal mortality both in developed and developing nations. Congenital abnormalities can have different patterns, prevalence rates, and risk factors across time and across different geographic regions. Aim: To find out the incidence of CA occurring among institutional live births and to study the associated maternal and perinatal risk factors in Northeast region of India. Materials and Methods: This retrospective observational study was carried out in the Neonatal Intensive Care Unit (NICU) at a Tertiary Care Hospital, Guwahati, Assam, India. The duration of the study was from January 2019 to December 2019. All newborns with CA during this period were included. Maternal and labour ward records were obtained. Data of maternal and antenatal factors such as age, parity, history of consanguinity, family history of congenital abnormality and mode of delivery were collected. The data were analysed using Microsoft Excel and Statistical Package for Social Sciences (SPSS) version 26.0 (IBM SPSS Statistics for Windows, Armonk, NY, USA). Proportion was calculated and the association was tested with Chi-square test and Fisher's-exact test. p<0.05 was considered to be statistically significant. Multivariate regression analysis was done to find the independent factor(s) for congenital anomaly. Results: During this study, there were 13530 deliveries, which include 13290 (98.2%) live births and 240 (1.8%) stillbirths. Out of 13290 newborns, 349 had one or more CA accounting for an incidence of 2.6%. The Gastrointestinal (GIT) System was the most commonly affected (33.8%), followed by the Central Nervous System (CNS) (20.9%) and craniofacial (11.7%) system. Cases of the congenital anomaly were found in 2.7% of multiparas, whereas in primiparas, the proportion was only 2.3%. In univariate analysis birth weight, gender, gestational age, maternal age, parity and mode of delivery showed significant association with incidence of congenital anomaly p<0.05*. Regression analysis showed three variables were significantly affecting the occurrence of CAs: gender Odd's Ratio (OR) (OR=0.341), gestational age (OR=32.7) and parity (OR=0.016). Conclusion: This study highlights the prevalence of GIT, CNS and craniofacial anomalies in this region. The major determinants for CAs were gestational age, gender and parity. [ABSTRACT FROM AUTHOR]

Introduction: Facility-Based Newborn Care program is one of the key initiatives launched by the Government of India under the National Rural Health Mission and RMNCH + A strategic program to improve the status of newborn health in the country. Under the program, efforts are being made to provide different levels of newborn care at the health facilities. Special newborn care unit (SNCU) is a neonatal unit in the vicinity of labor room which is to provide special care (all care except assisted ventilation and major surgery) for sick newborns. Aims and Objectives: We aimed to study the admission profile and treatment outcome of neonates admitted in SNCU. Materials and Methods: The present descriptive observational study with longitudinal design was conducted in the government-supported SNCU of District Hospital of Jalgaon district of Maharashtra which included all the neonates admitted in SNCUs from January 2013 to December 2019. The SNCU monthly report which is in a predefined format from the Ministry of Health and Family Welfare, Government of India, which includes data on admission information, reasons of admission, course of admission, and mortality reasons (if any) with treatment outcomes was used for data collection. The outcomes were classified into four groups, namely expired (died during the management), discharged (discharged after successful treatment), Left against medical advice (LAMA), and referred (referred to higher center for further management). Results: In the present study period (i.e., from January 2013 to December 2019), total 16,489 neonates were admitted to the SNCU. Out of them, 9895 (60.01%) were inborn. Majority (93.22%) of the deliveries were institutional deliveries. Meconium aspiration syndrome (MAS) (16.50%) was the most common indication for admission, followed by prematurity (12.68%), other low birth weight (LBW) (1000-2499 g) (11.96%), respiratory distress syndrome (RDS) (11.29%), and birth asphyxia (10.21%), respectively. 78.63% were discharged after successful management while 10.45% died during treatment. 3.97% were referred to higher center for further specialized management and 6.94% left the hospital against medical advice. Prematurity (25.70%) and RDS (25.48%) were the common causes of mortality. Birth asphyxia (15.12%), sepsis (7.73%), MAS (7.67%), and extremely LBW (7.62%) were other important conditions leading to the death of newborns. Conclusion: Thus, we conclude that the admission rate for inborn was higher as compared to outborn. MAS was observed to be the most common indication for admission, followed by prematurity, other LBW (1000-2499 g), RDS, and birth asphyxia, respectively. The discharge rate was 78.63% after successful management while the mortality rate was 10.45%. Prematurity, RDS, and birth asphyxia were the common causes of mortality. [ABSTRACT FROM AUTHOR]

Despite the high prevalence of inadequate gestational weight gain (GWG) and adverse pregnancy outcomes, very few studies have addressed the association between GWG and pregnancy outcomes in South Asia. Our objectives were to estimate the prevalence of GWG during the second and third trimesters within, below and above the Institute of Medicine (IOM) guidelines, and to estimate the effect of the rate and adequacy of GWG on gestational age at the time of delivery, weight, length, length‐for‐age z‐score (LAZ), weight‐for‐length z‐score (WLZ) and adverse pregnancy outcomes, namely prematurity, small‐for‐gestational age (SGA), low birth weight (LBW), stunting and wasting at birth. We analysed data from the intervention group of the Women and Infants Integrated Interventions for Growth Study (WINGS), which is an ongoing individually randomized factorial design study. Of the 1332 women analysed, 40.2% [95% confidence interval (CI) 37.5 to 42.8] had GWG below the IOM guidelines. For every 100‐g/week increase in GWG, birth weight increased by 61 g, birth length by 0.16 cm, LAZ score by 0.08 SD, WLZ score by 0.14 SD, and gestational age at birth by 0.48 days. Women with GWG below the IOM guidelines had a higher relative risk of adverse pregnancy outcomes (44% for LBW, 27% for SGA, 32% for stunting and 42% for wasting at birth) than women who had GWG within the IOM guidelines, except for prematurity. The association between GWG and LAZ scores at birth was modified by early pregnancy body mass index (BMI). GWG is a strong predictor of newborn anthropometric outcomes and duration of gestation but not prematurity. [ABSTRACT FROM AUTHOR]

Objectives: To determine the incidence, risk factors, and accuracy of a previously published risk estimator in predicting Bronchopulmonary dysplasia (BPD) in a very preterm cohort from India., Methods: A single-center prospective observational study was conducted in preterm neonates born at 23-30 wk of gestation with a birth weight of 501-1249 g. The incidence and risk factors of BPD were evaluated, and the accuracy of BPD prediction at six pre-specified time points using the National Institute of Child Health and Human Development (NICHD) BPD risk estimator was assessed by comparing the estimated risk with the observed rates., Results: A total of 310 neonates with mean gestation age of 28.7±1.5 wk and birth weight of 1023.6±171.4 g were enrolled in the study. The study cohort had 49.7% males and 32.3% neonates requiring resuscitation. Any BPD was observed in 54 (17.4%) neonates with severity being mild, moderate, and severe in 29 (53.7%), 17 (31.5%), and 8 (14.8%) neonates respectively. Hundred (32.3%) neonates died before discharge from the hospital. Sepsis, patent ductus arteriosus, retinopathy of prematurity, intraventricular hemorrhage, and blood transfusion were significant risk factors for the development of BPD. The calculator was accurate for the prediction of death or moderate-severe BPD on days 1 and 3 with the area under the curve of 0.82 and 0.77 respectively., Conclusions: The NICHD BPD estimator helped to accurately predict moderate-severe BPD early in Indian preterm infants., (© 2023. The Author(s), under exclusive licence to Dr. K C Chaudhuri Foundation.)

Surfactant replacement for respiratory distress syndrome (RDS) is currently guided by oxygen (FiO 2 ) requirement in preterm neonates. Lung ultrasound (LUS) has emerged as an important predictive tool; however, there is a paucity of evidence from developing countries. The objective of this study was to determine the diagnostic accuracy of the LUS score in comparison to standard criteria based on FiO2 requirement for prediction of surfactant requirement. In this prospective study, preterm neonates of < 34 weeks' gestation with RDS were included within 2 h of life. Surfactant was administered if the FiO 2 requirement exceeded 30%. Baseline characteristics, respiratory parameters, and LUS clips were recorded soon after birth and compared between the surfactant and non-surfactant groups. LUS scoring was later performed by masked assessors which was not used in the management of neonates. Among 82 neonates (mean gestation 30.6 weeks and weight 1375 g) included in the study, 33 (40.2%) received surfactant. The surfactant group had a higher Silverman score, required higher FiO 2 and mean airway pressure, and needed invasive ventilation more frequently. The mean (± SD) LUS score was significantly higher in the surfactant (9.4 ± 3.2) compared to the non-surfactant group (5.1 ± 2.1). The diagnostic accuracy of LUS scoring was determined by ROC curve analysis (AUC (95% CI): 0.83 (0.74-0.92), p < 0.01). A cutoff score of ≥ 8 for LUS was considered optimal for the prediction of surfactant requirement (sensitivity and specificity (95% CI) of 70% (51-84) and 80% (66-90), respectively).    Conclusion: Lung ultrasound is a valid diagnostic tool for the prediction of surfactant requirements in resource-limited settings. What is Known: • Lung ultrasound has a good diagnostic accuracy in predicting the need for surfactant administration in preterm neonates in developed countries, but its role in developing countries is unclear. What is New: • Lung ultrasound proved to be a valid diagnostic tool in predicting surfactant replacement therapy in resource-limited settings. • The diagnostic performance of lung ultrasound was better in neonates on non-invasive ventilation, compared to invasive ventilation., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Improved survival of preterm babies has also increased the incidence of neurodevelopmental problems. The first year of life is the most sensitive period for early intervention and hence targeting early detection principles to this age will be most useful. Aim: To study the neurodevelopmental profile of preterm babies (<35 weeks), born in a tertiary care hospital, till the age of 12 months of Corrected Gestational Age (CGA). Materials and Methods: The prospective cohort study was conducted between January 2014 and August 2015 at Christian Medical College and Hospital, Ludhiana, Punjab, India. All preterm newborns (<35 weeks) born in the tertiary care hospital during the study period were included. A total of 57 babies were enrolled. Neuromotor assessment at discharge and on follow-up at six and 12 months of CGA was done using Infant Neurological International Battery (INFANIB) and Developmental Assessment Scales for Indian Infants (DASII). One-way Analysis of Variance (ANOVA), Chi-square test, Fischer's-Exact test and inter-rater kappa agreement were used for statistical analysis. Results: A total of 78 preterm (35 weeks) were born, 21 were excluded, 57 were enrolled and 42 babies were followed-up till 12 months of CGA. The mean INFANIB score at discharge, 6 months and 12 months of CGA were 58.93±5.11, 68.74±7.71 and 82.95±5.90, respectively. At 12 months of CGA, 64% of the babies were normal, 33.33% were transient and 2.8% were abnormal as per INFANIB. The mean DASII score for Motor Development Quotient (MoDQ) at six and 12 months were 89.84 ±8.41 and 93.49±10.39, respectively, whereas Mental Development Quotient (MeDQ) at six and 12 months, were 70.39±10.54 and 65.58±13.19, respectively. The neuromotor assessment of infants with INFANIB compared well with the motor developmental score on DASII with an inter-rater kappa agreement of 1 (kappa=1). Conclusion: The preterm babies showed improvement in motor development quotient, but not in mental development quotient. Results of INFANIB and DASII matched in their motor assessment. The INFANIB is a reliable and quick tool for neuromotor assessment. [ABSTRACT FROM AUTHOR]

Objectives: LBW is the strong determinant of neonatal morbidity and mortality with a global prevalence of nearly 15%. India's prevalence, though not yet established, ranges from 16-30% and influenced by maternal nutritional status, antenatal care and associated maternal morbidity. Hence, the study was aimed to determine the influencing parameters for occurrence of LBW. Study Design: A retrospective observational study conducted for all live newborns delivered in a tertiary care centre during the study period of twenty four months. Methods: Data from institutional medical record section was recorded on predesigned questionnaire from a total of 1216 newborns. Results: The percentage of LBW was found to be 27.55% (335/1216) with a proportion of LBW to NBW babies was approximately 1:3. The occurrence of LBW was significantly higher in babies of anemic mothers (59.39%, P < 0.0001), young mothers (30.39%, P < 0.01), mothers with parity ≥ 3 (35.71%, P < 0.05), those with <3 ANC check-up (56.88%, P < 0.0001) and those with premature delivery (71.57%, P < 0.0001). Maternal anemia (OR 4.7, 95%CI 3.4-6.7, P < 0.001); ANC with <3 visits (OR 2.2, 95%CI 1.4-3.4, P < 0.01) and prematurity (OR 7.6, 95%CI 5.1-11.2, P < 0.0001) were considered as independent risk factor for LBW. Significant association of neonatal complications was found with LBW babies (OR 1.6, 95%CI 1.1-2.5, P < 0.05). Conclusions: Inadequate antenatal care, maternal anemia and other maternal illness causing premature delivery are considered critical determinants for LBW and thus associated with high neonatal mortality and morbidity. Continued focus for improving the overall maternal health status would lead to lowering burden of LBW. [ABSTRACT FROM AUTHOR]

Aim: Premature rupture of membranes (PROM) is a significant risk factor for various adverse neonatal outcomes such as prematurity, respiratory distress, birth asphyxia and early onset neonatal sepsis. Due to the public health relevance of this topic and its higher burden on health care services, this study was carried out to the identify risk factors and predictors of neonatal outcomes among babies born to mothers with PROM. Materials and Methods: A 3-year retrospective record based descriptive study with 254 neonates delivered at a tertiary care hospital in Coastal Karnataka, India was carried out. Results: The mean age of mothers was 28.57+/-4.3 years. Prematurity (39.3%) followed by hyperbilirubinemia (15.7%) and respiratory distress (12.2%) were the common complications seen, with a neonatal mortality rate of 2.3%. Antenatal complications (24.8%) and medical issues in the mother (13.7%) were the most common maternal risk factors associated with PROM. Although 59% cases delivered vaginally, Emergency Caesarean section was the mode of delivery in 97% of Caesarean cases. The median duration of latency was 590 minutes [interquartile (IQR) - 390-1,020 mins] with the highest median latency seen for 28-32 weeks of gestation which was 1,380 minutes (IQR: 672.5- 3,386.25 mins). Primiparity [Odds ratio (OR)- 1.99, 95% Confidence interval (CI)- 1.01-3.91, p=0.04] and preterm gestation (OR-2.12, 95% CI: 1.08-4.14, p=0.025) were factors associated with the increased latency period. A latency period >24 hours was found to be a significant factor associated with a poor Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score (OR- 5.83, 95% CI- 2.85-11.93, p<0.001) and Neonatal Intensive Care Unit (NICU) admission (OR-5.98, 95% CI- 2.95-12.14, p<0.001). Conclusion: PROM is associated with a significant risk of neonatal morbidity and mortality with the most common complications being prematurity and low birth weight. Prolonged PROM increases the risk of neonatal complications. Early recognition and prompt management prevents the delay in intervention and also reduces the risk of neonatal complications. [ABSTRACT FROM AUTHOR]

Objective: The aim of study was to study morbidity and mortality profile of newborns admitted to Sick Newborn Care Unit (SNCU) and to assess their survival rate over a period of 3 years. Materials and Methods: It was a observational retrospective study done over a span of 3 years from January 2017 to December 2019. The case records of all neonates admitted to SNCU during this period were scrutinized. The birth weight, gestational age at birth, morbidity profile, mortality profile were noted down. Results: Main causes of admission were found to be low birth weight (LBW), Prematurity, birth asphyxia, neonatal sepsis, and neonatal hyperbilirubinemia. Prematurity accounted for 46.3%, 47.42% and 45.34% of NICU admissions over 3 years. LBW newborns accounted for 52.81%, 49.11% and 42.63% of total admissions. Neonatal hyperbillirubinemia accounted for 40.71%, 47.79% and 52.69% of total admissions. Major causes of mortality were found to be sepsis, birth asphyxia and prematurity. Sepsis was observed to be cause of mortality in 33.01%, 37.72% and 23.32% of total deaths. Prematurity and hyaline membrane disease accounted for 30.62%, 23.17% and 33.18% of total deaths. Mortality rates were found to be very high in <1000 gm weight group (71.7%, 69.2%, 68.7%) over 3 years. Severe Birth asphyxia was found to be cause in 27.76%, 33.64% and 33.63% of total deaths. There was constant decline in mortality rate in all weight groups in LBW over 3 years. Overall Survival rate of newborns admitted was found to be 90.2%. Conclusion: Our study revealed that Prematurity, LBW, birth asphyxia, neonatal hyperbillirubinemia and sepsis were major causes for SNCU admission. Sepsis, birth asphyxia and prematurity were main contributors to mortality. Survival outcome of newborns mainly LBW and preterm has increased steadily over the last three years. [ABSTRACT FROM AUTHOR]

Introduction: Rupture of fetal membranes before completion of 37 weeks of gestation is called Preterm Premature Rupture of Membranes (PPROM), seen in 3% of all deliveries. PPROM occurring before 34 weeks are called early PPROM, and after 34 weeks are late PPROM. Risk of morbidity and mortality are more among the early preterm deliveries. It also increases the financial burden for the parents and society. A mother with premature rupture of membranes is at risk of developing chorioamnionitis, abruption, increased surgical intervention and postpartum endometritis. Neonates are at risk of respiratory distress syndrome, sepsis, intraventricular haemorrhage, necrotising enterocolitis and death. Aim: To evaluate the incidence, the clinical characteristics, factors leading to early PPROM (<34 weeks) in a tertiary care centre in Eastern India. Materials and Methods: It was a hospital based prospective cross sectional study, done in patients presenting with a history of PPROM at gestational age <34 weeks, admitted in the Dept. of Obstetrics and Gynaecology. The Institute of Medical Sciences and Sum Hospital, Bhubaneswar; over a period of 2 years. Factors leading to early PPROM, like association of anaemia, urogenital tract infection, threatened abortion in present pregnancy and history of PPROM, miscarriage in previous pregnancy are primary outcome and, admission to Neonatal Intensive Care Unit (NICU) and neonatal sepsis as secondary outcome were measured and analysed by SPSS v25 using proportion and chi-square test. Results: A total of 92 patients were analysed out of 108. Incidence of early PPROM was 3.08%. Maximum number of patients was in the age group 26-30 years, and primigravida accounted for 52.20%. Risk factors identified for early PPROM were history of PPROM in previous pregnancy, seen in 20 (21.7%) pregnancy, 28.30% patients had history of one or more previous abortions, 10.9% (n=10) had threatened miscarriage in index pregnancy, 26 (28.3%) had urinary complaints, 21 (22.8%) had leucorrhea. Positive urine cultures were seen in 19 (20.7%), with E. coli being the most common isolated organism. Anaemia was seen in 55 (60%), other associated conditions were hypothyroidism in 12 (13%), gestational diabetes mellitus 9 (9.7%), hypertensive disorders in 4 (4.3%), uterine myomas and polycystic ovarian syndrome in 3 (3.2%) patients in each category. High rate of neonatal sepsis was observed in patients with positive urine cultures, but no association with positive high vaginal swab cultures. About 77 (83.7%) babies were admitted to the NICU. Conclusion: History of PPROM in previous pregnancy and anaemia, urogenital tract infections in present pregnancy has association with premature rupture of membranes. The finding of the study suggests early identification and treatment of these factors can reduce the incidence of PPROM. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the existing status of human milk banks in India with reference to infrastructure, human resources, funding mechanisms, operating procedures and quality assurance. Methods: A pretested questionnaire was administered to 16 out of 22 human milk banks across India, operational for more than one year prior to commencing the study. Results: 11 (69%) milk banks were in government or charitable hospitals; only 2 (12.5%) were established with government funding. 8 (50%) had a dedicated technician and only 1(6%) had more than five lactation counsellors. Milk was collected predominantly from mothers of sick babies and in postnatal care wards followed by pediatric outpatient departments, camps, satellite centers, and homes. 10 (63%) reported gaps between donor milk demand and supply. 12 (75%) used shaker water bath pasteurizer and cooled the milk manually without monitoring temperature, and 4 (25%) pooled milk under the laminar airflow. 10 (63%) tracked donor to recipient and almost all did not collect data on early initiation, exclusive breastfeeding or human milk feeding. Conclusion: Our study reports the gaps of milk banking practices in India, which need to be addressed for strengthening them. Gaps include suboptimal financial support from the government, shortage of key human resources, processes and data gaps, and demand supply gap of donor human milk. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the incidence of fetal inflammatory response syndrome (FIRS) in preterm neonates and correlate it with immediate and one-year neurodevelopmental outcome.Materials and Methods: This prospective observational analytical study, in preterm neonates with gestational age between 26 and 34 weeks was conducted from May 2014 to December 2015 in a tertiary care hospital in South India. FIRS was defined as the presence of either elevated levels of interleukin-6 (IL-6) in cord blood ≥11 pg/ml and/or the placental histopathology showing evidence of fetal inflammatory response. One hundred and twenty neonates were recruited. During delivery 2 ml cord blood for interleukin-6 and placenta were collected and stored appropriately. Based on presence/absence of FIRS (IL-6 in cord blood ≥11 pg/ml and or features of placental fetal inflammation), neonates were grouped into two groups. The neonatal and maternal characteristics between two groups were compared. The short-term outcome parameters during NICU stay and neurodevelopmental outcome at one year of corrected age was compared between groups.Results: Among the 120 infants studied, 19 expired. Out of 101 babies discharged, 87 were followed up till corrected 1 year of age. On examination of placenta and cord blood, 50 neonates had evidence of FIRS (41.6%). So there were 50 neonates in FIRS and 70 in NO-FIRS group. The mean gestational age, birth weight, and gender distribution were comparable between the two groups. Mortality [OR: 2.44 (CI: 1.14-5.26)] and early hypotension [OR: 2.13 (CI: 1.1-4.2)] were significantly higher in the FIRS group. The neurodevelopmental assessment at corrected age of 1 year showed that infants with FIRS had lower mean motor developmental quotient by developmental assessment scale for Indian infants (DASII) [87.6 ± 9.15 versus 93.07 ± 9.3, p < .04].Conclusions: FIRS has a significant role on survival and neurodevelopmental outcome of preterm infants. [ABSTRACT FROM AUTHOR]

Objective: To determine whether oral clindamycin reduces the risk of preterm birth (PTB) in women with abnormal vaginal microflora as evidenced by a vaginal pH ≥5.0.Design: Randomised double-blind placebo-controlled trial.Setting: Rural southern India.Population: Pregnant women with a singleton fetus between 13+0/7 weeks and 20+6/7 weeks.Methods: Pregnant women were recruited during prenatal visits in Karnataka, India, from October 2013 to July 2015. Women were required to have a singleton fetus between 13+0/7 weeks and 20+6/7 weeks and an elevated vaginal pH (≥5.0) by colorimetric assessment. Participants were randomised to either oral clindamycin 300 mg twice daily for 5 days or an identical-appearing placebo.Main Outcome Measures: The primary outcome was the incidence of PTB, defined as delivery before 37+0/7 weeks.Results: Of the 6476 screened women, 1727 women were randomised (block randomised in groups of six; clindamycin n = 866, placebo n = 861). The demographic, reproductive, and anthropomorphometric characteristics of the study groups were similar. Compliance was high, with over 94% of capsules being taken. The rate of PTB before 37 weeks was comparable between the two groups [clindamycin 115/826 (13.9%) versus placebo 111/806 (13.8%), between-group difference 0.2% (95% CI -3.2 to 3.5%, P = 0.93)], as was PTB at less than 34 weeks [clindamycin 40/826 (4.8%) versus placebo group 37/806 (4.6%), between-group difference 0.3% (95% CI -1.8 to 2.3%, P = 0.81)]. No differences were detected in the incidence of birthweight of<2500 g, <1500 g, miscarriage, stillbirth or neonatal death.Conclusion: In this setting, oral clindamycin did not decrease PTB among women with vaginal pH ≥5.0.Tweetable Abstract: Oral clindamycin between 13+0/7 and 20+6/7 weeks does not prevent preterm birth in women with a vaginal pH ≥5.0. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal sepsis is a leading cause of neonatal mortality and morbidity in the world. The objective of the current study was to detect the common causative microorganisms of neonatal sepsis and their antimicrobial resistance patterns in a rural secondary hospital in Tamil Nadu, India. Materials and Methods: Neonates (0-28 days) admitted to this newborn care unit from October 2013 to September 2015, with a diagnosis of probable sepsis were studied. All the enrolled babies had blood cultures taken and were followed up till final outcome, which was discharge or death, irrespective of culture result. Univariate analysis was performed for factors associated with culture positivity, generating odds ratios, and confidence intervals. Results: Among the 107 babies with a diagnosis of probable sepsis, 28 (26.2%) had shown bacteria in culture. The majority (94.4%) were of early-onset sepsis. The predominant organisms were Staphylococcus aureus (10/28) and Klebsiella (6/28). 100% of Gram-negative bacilli and 90% of Staphylococcus were resistant to Ampicillin. Gentamicin resistance among Gram-negative bacilli and Staphylococcus was 52.9% and 20%, respectively, while third-generation cephalosporin resistance was 31.2% and 20%, respectively. Among the neonates diagnosed as probable sepsis, idiopathic prematurity (P = 0.007) was found to have a statistically significant association with culture-positive sepsis. Conclusion: The culture positivity rate among the neonates with probable sepsis in the current study was 26%. An alarmingly high degree of antibiotic resistance observed calls for robust infection control practices and an urgent evaluation and development of individual and national antibiotic policies for neonatal sepsis. [ABSTRACT FROM AUTHOR]

India's child mortality rate has dropped by more than half since 1990 but it still recorded the world's highest number of deaths among children below age five in 2013. India registered 1.34 million under-five deaths in 2013, the highest in the world. Infant and under five mortality rates are excellent indicators of health status of the children. India's infant mortality rate fell from 88 deaths per 1,000 live births in 1990 to 41 in 2013, while the neonatal mortality rate fell from 51 deaths per 1,000 live births to 29. About half of the all under-five deaths occur in only five countries - India, Nigeria, Pakistan, Democratic Republic of the Congo and China. Two-thirds of neonatal deaths occur in just 10 countries, with India accounting for more than a quarter of such deaths. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal mortality contributes to 40% of infant mortality rate (IMR). Over the years, the IMR has reduced worldwide, as well as in India, but neonatal mortality rate has not decreased proportionately. We have taken up this study so as to ascertain the causes of morbidity prevalent in the neonates admitted in Neonatal Intensive Care Unit (NICU) of a teaching hospital. The teaching hospitals cater to a large population, being a referral center and having majority of facilities required for the adequate care of sick newborn babies. Materials and Methods: The study is conducted in NICU of a teaching hospital admitted within 24 h of birth in central India over a period of 1-year. Results: One thousand three hundred and eighty-eight newborns admitted within 24 h of birth were included in the study. About 63.4% were male neonates, (Male:female 1.7:1). The low birth weight babies were 63.5% in our study. Respiratory distress was present in 47.2% of neonates, meconium aspiration syndrome being the most common cause of respiratory distress. Neonatal sepsis accounted for morbidity in 45.10% of neonates, with Klebsiella being the most common organism grown in the blood culture. The incidence of congenital anomalies was 5.4% with cardiac anomalies being most common. The neonatal mortality was found to be 26.6% in our study. Neonatal sepsis and birth asphyxia were the two most common causes of neonatal mortality in the study. Extremely low birth weight neonates had the highest case fatality rate in the study, which indicates the need to develop an efficient group of professionals in teaching hospitals who will provide highly specialized and focused care to this cohort of vulnerable neonates. Conclusion: Our study has shown respiratory distress, perinatal asphyxia, and sepsis as the predominant causes of neonatal morbidity. All three are preventable causes, and our health-care programs should be directed toward addressing the risk factors in the community responsible for the development of these three morbidities. The preterm and low birth weight babies had significantly high mortality even with standard intensive care; therefore a strong and effective antenatal program with extensive coverage of all pregnant females specifically in outreach areas should be developed which will help in decreasing preterm deliveries and also lower the incidence of low birth weight babies. [ABSTRACT FROM AUTHOR]

Objective: Topical emollient application reduces trans-epidermal water loss (TEWL) in preterm neonates. Coconut oil used traditionally for infant massage in India has not been evaluated for the same.Patients and Methods: Very low birth weight (VLBW) neonates were randomized at 12 h of age to Oil (n = 37) or Control (n = 37) groups. Oil group neonates received twice-daily coconut oil application without massage, and Control group received standard care. TEWL was measured every 12 h using an evaporimeter till Day 7 when skin swabs were obtained for bacterial growth and skin condition was assessed using a validated score.Results: Birth weight (g; mean ± SD: 1213 + 214 vs. 1164 + 208, p = 0.31), gestation [week; median (interquartile range): 32 (31-33) vs. 32 (29-33), p = 0.10] and other baseline variables were comparable. TEWL was significantly reduced (g/m(2)/h, mean difference: -6.80, 95% confidence interval: -3.48, -10.15; p < 0.01) with better skin condition and lower bacterial growth in the Oil group (20% vs. 60%, p < 0.01).Conclusion: Coconut oil application reduced TEWL without increasing skin colonization in VLBW neonates.Clinical Trials Registration: NCT01758068. [ABSTRACT FROM AUTHOR]

In India, the high neonatal and infant mortality rate is due in part to an increasing number of preterm and low birth weight (LBW) infants. Given the immaturity of immune system, these infants are at an increased risk of hospitalization and mortality from vaccine-preventable diseases (VPDs). In this narrative review, we screened the scientific literature for data on the risk of VPDs, vaccination delay and factors related to it in Indian preterm and LBW infants. Although routine childhood vaccinations are recommended regardless of gestational age or birth weight, vaccination is often delayed. It exposes these infants to a higher risk of infections, their associated complications, and death. After-birth complications, lack of awareness of recommendations, vaccine efficacy and effectiveness and concerns related to safety are some of the common barriers to vaccination. Awareness campaigns might help substantiate the need for (and value of) vaccination in preterm and LBW infants.

Objectives: To determine the prevalence of anemia in pregnant women and characterize its effect on neonatal outcome in Northeast India. Patients and methods: Four hundred and seventy mothers and their newborn infants during a one month period were included. The association between maternal hemoglobin (Hb) at delivery and neonatal outcomes were determined. Results: Anemia (Hb < 110 g/L) was present in 421 (89.6%) mothers with 35 (8.3%) having severe anemia(Hb < 70 g/L). After adjusting for maternal and neonatal variables, each 10 g/L decrease in maternal Hb was associated with 0.18 week decrease in gestational length ( p = 0.003) and 21 g decrease in birth weight ( p = 0.093). Severe maternal anemia was associated with 0.63week (95% CI, 0.03-1.23week) shorter gestation, 481 g (95% CI, 305-658 g) lower birth weight and 89% increased risk of small-for-gestation (OR 1.89, 95% CI, 1.25-2.86)in the offspring, compared with those born to mothers without anemia ( p < 0.001). Conclusion: Maternal anemia was highly prevalentin this population. Lower gestational age and birth weight, and increased risk of small-for-gestation were associated with maternal anemia, especially when maternal Hb was <80 g/L. Maternal anemia needs urgent attention to improve neonatal outcome in this population. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to evaluate outcome of pregnancies in women with rescue cerclage for cervical insufficiency. Material and Methods A retrospective study of all women who underwent rescue cerclage between 2002 and 2011 at an advanced tertiary care perinatal institute in India was conducted. Data retrieved from medical records was used to explore potential associations with prolongation of pregnancy beyond 28 weeks. Results The mean (standard deviation) gestational age at cerclage was 21.9 (2.7) weeks for the 74 women in the study. The McDonald technique was the preferred method for rescue cerclage (91.9%). All women received antibiotics; tocolytics were used in 35.1% and progesterones in 62.2% of women. The mean prolongation of pregnancy was 7.4 weeks with 42.0% women delivering after 28 weeks and 30.4% after 34 weeks. The take-home-baby rate was 50.7% (95% confidence interval: 38.7-62.6%). Postoperative vaginal infection was present in 16.2% of women, preterm premature rupture of membranes in 31.1% of women and neonatal sepsis in 5.8% of neonates. Cerclage placement after 20 weeks and negative pathogenic organisms in vaginal swab culture were significantly associated with delivery beyond 28 weeks. Conclusions Although half of the women had successful pregnancy outcomes after rescue cerclage, pregnancy extended from previability to prematurity in most of them. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate birthweight-specific neonatal mortality and perinatal interventions in major medical centers in developed and developing countries. Methods: A survey was developed and electronically mailed to 13 medical centers participating in the Global Network for Perinatal and Reproductive Health (GNPRH). The ability of a center to provide requested data was assessed. The mortality rates and use of specific perinatal interventions in centers in developing countries were compared with developed countries. Results: Nine centers in developing countries responded to the survey, and three centers in developed countries were used for comparison. Data collection was highly variable. Most developing country centers were able to provide data by birthweight but not by gestational age. The differences in mortality rates between developing and developed countries were more pronounced at lower gestational ages and birthweights. A difference was found in perinatal interventions between developing and developed countries. In the former, viability was generally considered 28 weeks, and the gestational age at which cesarean sections were usually performed for the sake of the fetus at preterm gestations varied from 26 to 37 weeks. Most centers did not routinely induce for pPROM; only five out of nine centers used antibiotics to prolong latency. Most centers used tocolysis beginning at 26–28 weeks through 32–37 weeks, and a variety of tocolytic agents were used. Most centers routinely used corticosteroids for preterm infants, and all centers employed repeat weekly steroid dosing if undelivered. Conclusions: Despite the fact that the GNPRH centers included in this study represent some of the best health care available in these countries, they lag far behind centers in developed countries in neonatal mortality rates and their use of various obstetric practices. Furthermore, incomplete and inconsistent data collection complicates the evaluation of the factors contributing to high neonatal mortality rates. [Copyright &y& Elsevier]