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Less invasive surfactant administration (LISA) has evolved as an alternative method for surfactant administration. An anonymous web-based survey of 22 questions was designed and sent to 127 neonatologists in India. Seventy-seven (61%) responses were returned from 22 states across India. Among 77 participants, 53 (68.8%) were using LISA, and amongst them, 19 (35.8%) were using LISA as the preferred method. Twenty-one (39.6%) LISA-using respondents learned the technique of LISA by watching online videos, whereas 20 (37.7%) acquired this skill during in-house training sessions. Nineteen (35.8%) centers were not using any premedication before performing LISA. Twenty (37.7%) participants notified regurgitation of surfactant needing a repeat dose as the most common problem encountered while performing LISA. The most common reason for not using LISA was lack of training (n = 20, 83.33%). Though LISA is a promising method of surfactant administration, not many centers prefer LISA in India due to the absence of uniform standardized training.

In this systematic review and meta-analysis, we attempted to determine the most appropriate feed initiation and advancement practices in preterm neonates with antenatal Doppler abnormalities.We included randomized controlled trials comparing different feed initiation and advancement practices in neonates with antenatal Doppler abnormalities. The databases of PubMed, Embase, Cochrane, CINAHL, Scopus, and Google Scholar were searched on February 25, 2022. The risk of bias was assessed using the Risk of Bias tool, version 2. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RevMan 5.4 was used for data analysis.Of the 1499 unique records identified, 7 studies were eligible for inclusion (6 on feed initiation, 1 on feed advancement). Early enteral feeding did not increase NEC stage 2 or more [risk ratio (RR) 1.12, 95% confidence interval (CI) 0.71-1.78; 6 studies, 775 participants] and mortality (RR 0.83, 95% CI 0.47-1.48; 5 studies, 642 participants). A trend was noted towards an increase in feeding intolerance (RR 1.23, 95% CI 0.98-1.56; 5 studies, 715 participants). There was a significant reduction in age at full enteral feeds, duration of total parental nutrition, and rates of hospital-acquired infections. Rapid feed advancement decreased the age at full enteral feeds without affecting other outcomes. The overall certainty of the evidence was rated low. Heterogeneity was not significant.There is low-certainty evidence that early feed initiation in preterm neonates with antenatal Doppler abnormalities does not increase rates of NEC and mortality. There is insufficient data on the speed of feed advancement.

Various studies validated and compared Score for Neonatal Acute Physiology with Perinatal extension-II (SNAPPE-II) and Clinical Risk Index for Babies-II (CRIB-II) admission sickness severity scores for predicting survival, but very few studies compared them for predicting the morbidities in preterm infants. In this multicenter prospective observational study, SNAPPE-II and CRIB-II newborn illness severity scores were compared for predicting mortality and morbidities in infants with gestational age of ≤ 32 weeks. Major morbidities were classified as bronchopulmonary dysplasia, abnormal cranial ultrasound (presence of intraventricular hemorrhage grade III or more or periventricular leukomalacia grade II to IV), and retinopathy of prematurity requiring treatment. Combined adverse outcome was defined as death or any major morbidity. Comparison of the scoring systems was done by area under the curve (AUC) on receiver operating characteristics curve (ROC curve) analysis. A total of 419 neonates who were admitted to 5 participating NICUs were studied. The mortality rate in the study population was 8.8%. Both CRIB-II (AUC: 0.795) and SNAPPE-II (AUC: 0.78) had good predictive ability for in-hospital mortality. For predicting any one of the major morbidities and combined adverse outcome, CRIB-II had better predictive ability than SNAPPE-II with AUC of 0.83 vs. 0.70 and 0.85 vs. 0.74, respectively.In infants with gestational age of ≤ 32 weeks, both CRIB-II and SNAPPE-II are good scoring systems for predicting mortality. CRIB-II, being a simpler scoring system and having better predictive ability for major morbidities and combined adverse outcome, is preferable over SNAPPE-II.• SNAPPE-II and CRIB-II scores have good predictive ability on in-hospital mortality in preterm neonates.• SNAPPE-II and CRIB-II both have good predictive ability for mortality, but CRIB-II has better ability for short-term morbidities related to the prematurity.

To compare outcomes of preterm neonates born through assisted reproduction techniques (ART) and non-ART conception.This retrospective cohort study included very preterm neonates (26 weeks to 31 weeks) admitted to our neonatal unit over a six year period from 2014 to 2019. The primary outcome was composite adverse outcome of mortality or any of the major morbidities i.e., intraventricular hemorrhage (IVH) grade ≤3, periventricular leukomalacia (PVL) grade ≤2, bronchopulmonary dysplasia (BPD) at 36 weeks, and retinopathy of prematurity (ROP) requiring treatment.Total of 759 neonates (253 in ART group, 506 in non-ART group) were included after propensity score matching for gestational age, sex, and small for gestational age (SGA). Neonates in ART group had similar rates of composite adverse outcome [aOR (95% CI) 0.86 (0.55 - 1.36)], mortality [0.93, (0.53- 1.64)] BPD [1.18, (0.37 - 3.76)]; ROP requiring treatment [ 0.49 (0.14-1.71], and other morbidities.Very preterm neonates born through ART were not at increased risk of adverse neonatal outcomes.

Various methods of screening or diagnosis of severe hyperbilirubinemia like transcutaneous bilirubinometer and laboratory testing havemethodological or practical limitations. In this perspective, we designed and evaluated an invasive but simple screening Color Card method in rapid assessment of various levels of bilirubin categories.This prospective comparative diagnostic study objectives were to create "Color Card" initially by yellow color shades that fall into 4 bilirubin categories, i.e. TSB up to 7 mg/dl, 7.1 to 12 mg/dl, 12.1 to 18 mg/dl and18 mg/dl from the samples analyzed by diazo method, and to study its sensitivity and specificity for the diagnosis of moderate or severe hyperbilirubinemia in comparison to total serum bilirubin (TSB) by diazo method.Out of total 188 samples obtained, 134 were unique patients. The specificity, negative predictive value and accuracy of the color card for the observations made by observer 1 comparing with lab TSB were95% for clinically important categories of7 mg/dl and18 mg/dl. The overall accuracy of color card in measuring various TSB ranges varied from 75% to 96.8%. The agreement between two observers was 85.6% (Cohen's kappa co-efficient: 0.61,Bilirubin color card has good accuracy and may be very useful in the low resource settings, especially in the first referral units and community settings, where laboratory TSB estimation is not available easily. However, it requires centrifugation and easier methods of centrifugation will make this method simpler.

Neonatal pneumonia contributes significantly to mortality due to pneumonia in the under-five age group, but the predictors of mortality are largely unknown.To evaluate the clinical and microbiological characteristics and other risk factors that predict mortality in neonates admitted with pneumonia in tertiary care centres.Prospective observational cohort study.Term and preterm (32 weeks to 36 6/7 weeks) neonates (28 days of life) admitted with clinical and radiological features suggestive of pneumonia.Baseline sociodemographic data, clinical details, blood culture and nasopharyngeal swabs for virologic assay (RT PCR for RSV, Influenza) were collected at admission and the neonates were observed throughout their hospital stay.The primary outcome was predictors of mortality in neonatal pneumonia.Five hundred neonates were enrolled in the study. Out of 476 neonates with known outcomes, 39 (8.2%) died. On multivariate analysis, blood culture positive sepsis was independently associated with mortality (adjusted OR 2.51, 95% CI1.23 to 5.11; P-0.01).Neonates with blood culture positive pneumonia positive are at a higher risk of death.

To compare SNAPPE-II and STOPS admission severity scores in neonates admitted to neonatal intensive care unit (NICU) with a gestational age of ≥ 33 wk.In this multicenter, prospective, observational study, the sickness scoring was done on all the neonates at 12 h after admission to the NICUs. The scoring systems were compared by the area under the curve (AUC) on the receiver operating characteristics (ROC) curve.A total of 669 neonates with gestational age ≥ 33 wk (mortality rate: 2.4%), who were admitted to five participating NICUs within 24 h of birth, were included. Both SNAPPE-II and STOPS had the good discriminatory and predictive ability for mortality with AUCs of 0.965 [95% confidence interval (CI): 0.94-0.98] and 0.92 (95% CI: 0.87-0.99), respectively. The STOPS scoring system with a cutoff score ≥ 4 on the ROC curve had 85% accuracy, whereas the SNAPPE-II cutoff score ≥ 33 on the ROC curve had 94% accuracy in predicting mortality.In infants with the gestational age of ≥ 33 wk, SNAPPE-II and STOPS showed similar predictive ability, but the STOPS score, being a simpler clinical tool, might be more useful in resource-limited settings.

Background: Hypothermia is a well-known contributor to neonatal morbidity and mortality, especially for preterm and low-birth weight neonates. Identifying the predictors for admission hypothermia which are specific to the settings is important to initiate quality improvement projects and improve clinical outcomes. Methods: Study was conducted over a period of 6 months from 1 April to 31 September 2018. All inborn infants needing neonatal intensive care unit (NICU) admission were eligible for the study. The study involved measuring temperatures at exit from delivery room (DR) and at admission to NICU. Hypothermia was defined as core admission temperature Results: One hundred and ninety-three infants were enrolled in the study. The incidence of admission hypothermia (Conclusion: Significant proportion of neonates is hypothermic at the time of admission to NICU. DR temperature significantly predicts hypothermia at admission in neonates needing NICU admission.

A male term neonate is born to a 25-year-old, gravida 3 woman in a third-degree consanguineous marriage with 2 previous term neonatal deaths. Her first child was male and had an unexplained death at 14 days of age at home. Her second child was female and also had an unexplained death at 11 days of age. The antenatal period during this current pregnancy is uneventful except for a diagnosis of gestational diabetes mellitus, which required treatment with insulin during the third trimester. The woman’s blood glucose values were maintained in the normal range in the antepartum and intrapartum periods. Her antenatal scans are normal. This neonate is delivered at 38 weeks of gestation via a planned lower-segment cesarean section (LSCS) in view of a previous LSCS and a history of 2 unexplained neonatal deaths. The neonate cries immediately after birth and does not require any resuscitation. His Apgar scores are 8, 8, and 9 at 1, 5, and 10 minutes after birth, respectively. The placenta weighs 380 g and is normal on gross examination. The infant’s birthweight, length, and head circumference are 3,650 g (86th percentile), 51 cm (77th percentile), and 35.5 cm (86th percentile), respectively. The initial examination findings are normal and show that the infant does not have any obvious external anomalies, edema, or facial dysmorphisms; no skin lesions, limb abnormalities, or genital abnormalities are noted. Blood glucose monitoring performed as per protocol and all test results are normal. Because of the history of 2 previous neonatal deaths, electrocardiography, echocardiography, and cranial ultrasonography are performed before discharge, results of which are all normal. The expanded newborn screening panel is sent before discharge. The neonate is discharged from the hospital on day 4 after birth and the family is advised to follow-up closely with the pediatrician. On the 7th …

Hypothermia is a common problem especially in preterm neonates and has been associated with increased neonatal mortality and morbidities. The objective of our study was to look into the distribution of admission temperature among VLBW neonates getting admitted to the NICU, association of admission temperatures to selected neonatal morbidities/mortality, and to evaluate for modifiable factors contributing to hypothermia.Infants with birth weight between 500 and 1499 g and gestation ≥ 25 weeks without major congenital malformations delivered between October 2017 and March 2020 who were admitted directly from the delivery room to the NICU were included in the study. Data were collected prospectively on perinatal/birth characteristics to look for their association with admission hypothermia, and to look into the association of admission temperature with selected neonatal morbidities/mortality.There were a total of 538 neonates with the mean birth weight of 1206 ± 271 g included in the study. Mean admission temperature was 35.8 ± 1.3 °C. Low delivery room temperature was the most important contributor to admission hypothermia. Also, 3.3% of neonates were hyperthermic at admission to NICU, all of them having been delivered to mothers with intrapartum pyrexia. On adjusted analysis, we found that low admission temperature significantly increased therisk of adverse composite neonatal outcomes with admission temperature34.5 °C having 42% increased risk of the adverse outcome when compared to normothermic neonates.Admission hypothermia remains a common problem in preterm neonates which is significantly associated with adverse neonatal outcome.

Shock is a state of circulatory dysfunction and its diagnosis is complex in neonates. Hemodynamic assessment using echocardiography has potential to guide better management regimes in neonates with shock. Objective of this study is to analyze changes in the echocardiographic parameters in preterm neonates with shock at presentation and after resolution. In this prospective pragmatic Cohort study, eligible neonates with shock were monitored for changes in echocardiographic parameters at onset of shock and after resolution of shock. Paired data analysis was done for observed changes in the parameters. Based on initial clinical parameters and echocardiographic parameters, infants were assigned into different types of shock. Data of 37 infants were analyzed for baseline clinical and echocardiographic parameters, and data of 31 infants were analyzed for the changes in the observed parameters after shock resolution. Statistically significant changes were observed in inferior vena cava collapsibility index (ICI), left ventricular end diastolic volume (LVEDV), isovolemic ventricular relaxation time (IVRT), left and right ventricular stroke volume, and ejection fraction (EF). There was no agreement between clinical and echocardiographic definitions of shock.Conclusion: We noticed shock has overlapping pathophysiologic features. Our study highlights the importance of baseline documentation of echocardiographic parameters of all infants who are at risk of shock and repeat echocardiography at onset of shock to observe the changes in ICI, LVEDV, IVRT, stroke volume, and EF. This would guide pathophysiological management of shock in neonates. What is Known: • In neonates pathophysiology of shock is overlapping. • Echocardiography can help in better understanding and management of shock. What is New: • Study gives median changes in major echocardiographic parameters in neonatal shock. • These changes can guide for selection of volume and inotropes in management.

Shock is an acute state of circulatory dysfunction. The diagnosis of shock is complex in neonates. The relative sensitivity of current clinical or laboratory findings for detecting shock is largely unknown, especially for preterm neonates. For preload assessment, inferior vena cava (IVC) collapsibility can be a useful bedside echocardiography parameter. plethysmography variability index (PVI) is a marker of fluid responsive shock in adults and children, but not well defined in neonates. In this prospective observational study, we evaluated the changes in PVI in preterm neonates with shock. Among the 37 infants enrolled in the study, the mean blood pressure (MAP) was 45 (± 4 mm of Hg) and none of infants had hypotension. The mean pulse pressure was 28 mm of Hg, the mean PVI was 28% (±5), the mean arterial blood gas pH was 7.20 (±0.07), and the mean base deficit was 9.9 (±2.53) at the onset of shock. Thirty (96.77%) of the 31 infants with resolution of shock showed decrease in PVI with an average decrease of 11% (±5). Conclusion: Significant proportion of neonates show an increase in PVI at the onset of shock.

To identify risk factors and outcomes associated with early failure of nasal continuous positive airway pressure (CPAP) in premature infants with respiratory distress (RD). This is a retrospective observational study of all the preterm infants with RD primarily supported on nasal CPAP and included in CPAP trials conducted at the study site. Data was collected from the raw excel sheets of the previous trials but limited to eligible patients from study site. Early CPAP failure was defined as the need for mechanical ventilation in the first 72 h after birth. Predictor variables for CPAP failure included baseline maternal and infant characteristics, CPAP care practices, morbidities and adjuvant therapies. The morbidities and outcomes were compared among infants with CPAP failure and CPAP success. Six hundred and fifty-two infants were enrolled in the study. Early CPAP failure was seen in 96 infants (14.7%, 95% CI: 12%–17.5%). On logistic regression, adjusting for gestation and year of study, time of starting CPAP in hours (OR 1.01, 95% CI: 1.003–1.013), time of surfactant administration in hours (OR 1.12, 95% CI: 1.05–1.19), InSurE (Intubate Surfactant Extubate) (OR 2.7, 95% CI: 1.43–5.06) and higher starting FiO2 (OR 1.03, 95% CI: 1.01–1.05) predicted early CPAP failure. Neonatal morbidities and hospital duration were significantly higher in infants who failed CPAP. Early starting of CPAP, InSurE, early surfactant administration, lower CPAP pressures and lower FiO2 at starting of CPAP were the important determinants of success.

Mother’s own milk (MOM) for premature infants is a complete nutrition. It is an ideal issue for a quality improvement (QI) initiative. To increase the proportionate usage of MOM as enteral feeds. A QI study conducted in Tertiary care NICU involving all eligible very low birth weight (VLBW) infants and mother dyads. The proportionate usages of MOM as enteral feeds were the main outcomes. Education, milk expression, and mother–infant interaction formed the key drivers. We studied 282 mother infant dyads during the QI period. The proportionate usage of MOM as the enteral feed increased from 55% (±34) at baseline to 80% (±27) during the intervention and to 88% (±16) in sustenance phase. A QI initiative resulted in 60% relative improvement in proportionate usage of MOM as enteral feeds in VLBW infants during hospital stay.

This prospective observational study was aimed to analyze the impact of a quality improvement project to reduce admission hypothermia on composite outcome of neonatal mortality and major morbidities. Infants with birth weight between 500 and 1499 g and gestation ≥ 25 weeks without major congenital malformations delivered between January 2018 and January 2020 who were admitted directly from delivery room to NICU were included in the study. Study period was divided in three phases including pre-intervention, intervention and post-intervention phase. There were a total of 368 VLBW infants included in the study. Mean admission temperature of neonates was 35.3 ± 0.6 °C, 36.0 ± 0.8 °C, and 36.4 ± 0.4 °C during pre-intervention, intervention, and post-intervention phase, respectively. Absolute incidence of composite outcome was 31%, 20%, and 13.2% during pre-intervention, intervention, and post-intervention phase, respectively. Risk of adverse composite outcome was significantly lower in post-intervention period as compared to pre-intervention period (aRR 0.68, 95% CI 0.49-0.92). Nosocomial sepsis and need for invasive ventilation was also significantly less in post-intervention period as compared to pre-intervention period.Conclusion: Implementation of thermoregulatory interventions best suited to local settings help in significant reduction of neonatal hypothermia, which in turn can help to improve neonatal outcomes. What is known: • Admission hypothermia is associated with adverse neonatal outcomes. • Implementation of quality improvement projects help reducing hypothermia incidence. What is new: • Implementation of quality improvement project to reduce admission hypothermia resulted in reduction in incidence of adverse composite neonatal outcome. • Also implementation of quality improvement project led to reduction in incidence of nosocomial sepsis and need of invasive ventilation.

Background Hypothermia is an important contributor to neonatal morbidity and mortality, more so in the preterm and extreme low birth weight infants. Methods Study was conducted over a period of 3 months from 1st January to 31st March 2018 with an aim of evaluating rate of change of temperature of newborn neonates from delivery to NICU admission and factors effecting rate of change of temperature in these neonates. A unique compact continuous temperature monitoring device was used for this study. Temperature changes in the baby were monitored with a help of smart phone where temperature is updated every 5 s. Results Thirty neonates with mean gestation of 31 ± 3 weeks were enrolled for study. Mean temperature at admission to NICU was 35.34 ± 0.74 °C. There was no temperature loss while stabilization of neonate under radiant warmer or during transport to NICU. Maximum temperature loss happened before baby reached to radiant warmer. Delivery room temperature and gestation were found to be most important factors effecting admission temperature to NICU. Conclusion Significant proportion of neonates after birth is hypothermic at admission to NICU. Low delivery room temperature and prematurity are associated with neonatal hypothermia. Implementing WHO recommendation of increasing delivery room temperature to 25 °C and above can help in reducing the incidence of neonatal hypothermia.

Introduction Early diagnosis and appropriate management of neonatal jaundice is crucial in avoiding severe hyperbilirubinemia and brain injury. A low-cost, minimally invasive, point-of-care (PoC) tool for total bilirubin (TB) estimation which can be useful across all ranges of bilirubin values and all settings is the need of the hour. Objective To assess the accuracy of Bilistick system, a PoC device, for measurement of TB in comparison with estimation by spectrophotometry. Design/methods In this cross-sectional clinical study, in infants who required TB estimation, blood samples in 25-µl sample transfer pipettes were collected at the same time from venous blood obtained for laboratory bilirubin estimation. The accuracy of Bilistick in estimating TB within ±2 mg/dl of bilirubin estimation by spectrophotometry was the primary outcome. Results Among the enrolled infants, 198 infants were eligible for study analysis with the mean gestation of 36 ± 2.3 weeks and the mean birth weight of 2368 ± 623 g. The median age at enrollment was 68.5 h (interquartile range: 48–92). Bilistick was accurate only in 54.5% infants in measuring TB within ±2 mg/dl difference of TB measured by spectrophotometry. There was a moderate degree of correlation between the two methods (r = 0.457; 95% CI: 0.339–0.561, p value < 0.001). Bland–Altman analysis showed a mean difference of 0.5 mg/dl (SD ± 4.4) with limits of agreement between −8.2 and +9.1 mg/dl. Conclusion Bilistick as a PoC device is not accurate to estimate TB within the clinically acceptable difference (±2 mg/dl) of TB estimation by spectrophotometry and needs further improvement to make it more accurate.

Among term and late preterm infants, hypoxic ischemic encephalopathy (HIE) is an important cause of mortality, and neurologic morbidity among survivors.The primary objective was to study the incidence of survival to discharge among late preterm and term infants with moderate or severe HIE. Secondary objectives were to explore variation in the management of HIE across participating sites and to identify the predictors of survival.Indian Neonatal Collaborative (INNC), a network of 28 neonatal units in India.Retrospective cohort.Late preterm (34-36 weeks) and term (37-42 weeks) infants with moderate to severe HIE from 2018-2019.The primary outcome was survival to discharge (including discharged home and transfer to other hospital). A multivariate logistic regression model was constructed to identify the predictors of survival.Of 352 infants with moderate or severe HIE, 59% received therapeutic hypothermia. Survival to discharge among infants with moderate or severe HIE was 82%. Severe HIE (aOR 0.04; 95% CI 0.02-0.10), persistent pulmonary hypertension (PPHN) (aOR 0.22; 95% CI 0.08-0.61) and requirement of epinephrine during resuscitation (aOR 0.21; 95% CI 0.05-0.84) were independently associated with decreased odds of survival to discharge.Survival to discharge among infants with moderate or severe HIE was 82%. Severe HIE, requirement of epinephrine during resuscitation and PPHN decreased the odds of survival.

Preterm neonates with antenatal doppler abnormalities are at increased risk of necrotizing enterocolitis (NEC). In these neonates, we did a meta-analysis to compare the impact of early versus late initiation of feeding, and slow versus rapid feed advancement on the important neonatal outcomes. The databases of PubMed, Embase, Cochrane central, CINAHL and google scholar were searched on 6th September 2020. We included all randomized controlled trials addressing the study objective(s). The risk of bias was assessed using the Risk of Bias tool, version 2. Certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Early feeding did not increase the incidence of NEC stage 2 or more (odds ratio/OR 1.27, 95% confidence interval/CI 0.83, 1.96; 6 studies, 772 participants) and mortality (OR 0.79, 95% CI 0.4, 1.57; 3 studies, 498 participants). A trend was noted towards an increased incidence of feeding intolerance (OR 1.37, 95% CI 0.98, 1.92). There was a significant reduction in time to reach full feeds, duration of total parental nutrition, duration of hospital stay, and rates of hospital-acquired infections. The time to regain birth weight was not different. Rapid feed advancement decreased the time to reach full feeds, without affecting other outcomes. The overall certainty of the evidence was rated low. Heterogeneity was not significant. Conclusion: There is low-certainty evidence to recommend early feed initiation in preterm neonates with antenatal doppler abnormalities. The data is insufficient to make a recommendation on the rapidity of feed advancement.

Growth chart aids in management by identifying at-risk neonates with abnormal growth. In this retrospective analysis of 1067 neonates of 26-31 wk gestational age, the utility of 3 growth charts (local population-based, Fenton-2013, and INTERGROWTH-21

Pediatricians play a key role in identifying neonates with hip instability or at risk for developmental dysplasia of the hip (DDH); however, the clinical practices related to screening and further management in India are unknown. A web-based survey was circulated to members of the National Neonatology Forum of India (NNFI). Of the 231 eligible responses, about 92% were from an urban setup. It was noted that 38% (88/231) had not diagnosed any DDH in the past 12 mo, 8% (17/224) had diagnosed cases beyond walking age, 50% (116/231) would pursue further evaluation in children 3 mo with risk-factors and normal hip exam, 53% (122/229) were aware of hip-safe swaddling, 30% (68/226) were comfortable with performing Ortolani and Barlow maneuvers and 50% (107/226) were aware of the current guidelines for the management of DDH. Almost all respondents (97.3%, 220/226) felt a need for a DDH care pathway for screening and early management in India. Thus, substantial deficits and variability in screening practices for DDH amongst pediatricians in India.

A late preterm male infant is born at 34 weeks’ gestation with a birthweight of 2,300 g via emergency cesarean section for preterm premature rupture of membranes. The antenatal visits and ultrasound scans are unremarkable. The neonate cries immediately at birth, and his Apgar scores are 8 and 8 at 1 and 5 minutes, respectively. In the first 3 days after birth, the neonate is treated at another hospital for respiratory distress syndrome with continuous positive airway pressure and surfactant. No feeds are started in the first 2 days as the neonate did not pass any stool. On day 4 after birth, the neonate is referred to us for abdominal distention and delayed passage of meconium. At admission, the infant is found to have cold stress, with a temperature of 96.8oF (36oC). The core peripheral temperature difference is 37.4oF (3oC). The infant’s heart rate is 160 beats/min, pulse volume is normal, and all peripheral pulses are well felt. The respiratory rate is 40 breaths/min and he is breathing normally with normal saturations in room air. Capillary refill time is normal and blood pressure is 84/58 mm Hg (mean 67 mm Hg) in the right upper limb. The infant’s weight at admission is 2,580 g (68th percentile), length is 47 cm (73rd percentile), and occipital frontal circumference is 33 cm (83rd percentile). No pallor is noted and the icterus is up to the thighs. There is no dysmorphism. The abdomen is distended and tense, and …

Close monitoring of growth pattern in preterm neonates is essential to identify any deviations from the normal pattern. But, there is no international consensus regarding how the growth of preterm neonates should be monitored or what constitutes the ideal pattern of growth in these premature infants.To compare the incidence of IUGREUGR in preterm neonates ≤32 weeks gestational age based on Fenton 2013 growth curves and Intergrowth-21 growth standards.Retrospective Cohort Study.Tertiary care neonatal unit with nearly 1000 admissions to the neonatal unit.All newborns with gestational age ≤32 weeks (230 6/7 days) admitted to the NICU within 24 h of birth over a period of 3 years from 1 January 2015 to 31 December 2017.Out of 821 neonates born during the study period 603 were included. The mean birth weight, length, and head circumference were 1356.683 ± 335.91 g, 39.244 ± 3.124 cm, and 27.819 ± 1.906 cm, respectively. The mean discharge weight, length, and head circumference were 1550.70 ± 185.122 g, 41.606 ± 2.026 cm, and 29.398 ± 1.221 cm, respectively. The proportion of infants identified as IUGR at birth with respect to weight, length, and head circumference on both the charts was 15.1, 14.4, and 9%, respectively. The proportion of infants identified as EUGR at discharge with respect to weight, length, and head circumference on both the charts was 45.7, 29.8, and 32.3%, respectively.The proportion of infants identified as IUGR at birth and EUGR at discharge differed on the usage of Intergrowth charts (Birth reference and postnatal) in comparison to Fenton growth charts. The infants identified as IUGR at birth by Intergrowth charts and not by Fenton growth charts had higher incidence of morbidities.

Introduction Establishing successful breastfeeding within the first hour of infant’s life has been shown to have an inverse relationship with maternal breastfeeding difficulties and decreased neonatal mortality. Patients and Methods We compared the effect of immediate breast crawl with standard care on maternal perception of breastfeeding, mother infant bonding and maternal satisfaction at hospital discharge, breastfeeding rates, infant weights at 6 weeks and at 6 months. Eligible pregnant women after birth were randomized. In the breast crawl group, immediate skin to skin contact was practiced till 1 hour or till the infant had the first breast feeding. In the control group no skin to skin contact was practiced. Results 200 mother infant dyads were enrolled in the study. Breast crawl was successful in 90% of the infants. No difference in breastfeeding rates was observed between the two groups at 6 weeks or at 6months age [94.8% (n= 97) vs. 95.7% (n=95), OR 0.99, 95% CI: 0.93-1.05 and 92.7% (n= 97) vs. 94.6% (n=93) OR 0.98 95% CI: 0.92-1.05]. The breastfeeding assessment score and maternal perception of breastfeeding and infant activity were significantly better in the crawl group (OR 10.2, 95% CI :5.12 -20). No difference in infant bonding scores was observed between the two groups. The mean weight at discharge was similar between the two groups. The mean infant weight at 6 months of age were significantly better in the crawl group [6767 ±843 grams vs. 6475 ±843 grams, p=0.018)]. Conclusion Breast crawl at birth improves the breastfeeding and maternal perception of breastfeeding at hospital discharge and the infant weights at 6 months of age. Strength Education and motivation of the mothers and labor room team, good breastfeeding rates in the control group are some of the unique features of this study. Limitation Consistent presence of the research assistant.

ObjectiveTo gain an understanding of the variation in available resources and clinical practices between neonatal units (NNUs) in the low-income and middle-income country (LMIC) setting to inform the design of an observational study on the burden of unit-level antimicrobial resistance (AMR).DesignA web-based survey using a REDCap database was circulated to NNUs participating in the Neonatal AMR research network. The survey included questions about NNU funding structure, size, admission rates, access to supportive therapies, empirical antimicrobial guidelines and period prevalence of neonatal blood culture isolates and their resistance patterns.Setting39 NNUs from 12 countries.PatientsAny neonate admitted to one of the participating NNUs.InterventionsThis was an observational cohort study.ResultsThe number of live births per unit ranged from 513 to 27 700 over the 12-month study period, with the number of neonatal cots ranging from 12 to 110. The proportion of preterm admissions ConclusionAMR is already a significant issue in NNUs worldwide. The apparent burden of AMR in a given NNU in the LMIC setting can be influenced by a range of factors which will vary substantially between NNUs. These variations must be considered when designing interventions to improve neonatal mortality globally.

The current study aims to compare the feeding outcome, morbidity and mortality in very low birth weight (VLBW) infants who received early colostrum (

A term, 2.9-kg male newborn with respiratory distress from birth is admitted to the NICU 4 hours after birth. He is born to a 30-year-old primigravida via cesarean section for prolonged labor. The antenatal period is uncomplicated by any obstetric illness. Scans for anomalies and growth are normal. There is no history of fever/rash in the antenatal period. She is diagnosed as having renal colic in the last trimester, for which aceclofenac, acetaminophen, and rabeprazole are prescribed. She has been taking these medications for 10 days before delivery. Her blood group is O positive. On examination, the infant has significant generalized subcutaneous edema (Fig 1). His heart rate is 155 beats/min with normal pulse volume and rhythm. His respiratory rate is 65 breaths/min and he is having mid-subcostal and intercostal retractions with a Silverman Anderson score of 3 out of 10. His noninvasive blood pressure is 65/35 mm Hg (mean 45 mm Hg) in the right upper limb. He is started on continuous positive airway pressure of 5 cm and is maintaining normal saturation fraction of inspired oxygen of 30%. There is no difference in pre- and postductal saturations. There is no evidence of growth restriction and his birthweight (2,900 g [28th percentile]), length (51 cm [77th percentile]), and head circumference (32 cm [9th percentile]) are all within normal limits. There is no obvious dysmorphism, syndromic features, or external congenital malformations. He has no pallor or …

BACKGROUND: Limited evidence exists on perinatal transmission and outcomes of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in neonates OBJECTIVE: To describe clinical outcomes and risk factors for transmission in neonates born to mothers with perinatal SARS-CoV-2 infection DESIGN: Prospective cohort of suspected and confirmed SARS-CoV-2 infected neonates entered in National Neonatology Forum (NNF) of India registry SUBJECTS: Neonates born to women with SARS-CoV-2 infection within two weeks before or two days after birth and neonates with SARS-CoV-2 infection OUTCOMES: Incidence and risk factors of perinatal transmission RESULT: Among 1713 neonates, SARS-CoV-2 infection status was available for 1330 intramural and 104 extramural neonates SARS-CoV-2 positivity was reported in 144 intramural and 39 extramural neonates Perinatal transmission occurred in 106 (8%) and horizontal transmission in 21 (1 5%) intramural neonates Neonates roomed-in with mother had higher transmission risk (RR1 16, 95%CI 1 1 to 2 4;P=0 01) No association was noted with the mode of delivery or type of feeding The majority of neonates positive for SARS-CoV2 were asymptomatic Intramural SARS-CoV-2 positive neonates were more likely to be symptomatic (RR 5, 95%CI 3 3 to 7 7;P

Background: \ud While there have been studies in adults reporting discordant empiric antibiotic treatment associated with poor outcomes, this area is relatively unexplored in children and neonates despite evidence of increasing resistance to recommended first-line treatment regimens.\ud \ud Methods: \ud Patient characteristics, antibiotic treatment, microbiology, and 30-day all-cause outcome from children

Objective Survival of preterm infants differs dramatically depending on birthplace. No previous studies have compared outcomes of preterm infants between low middle-income and high-income countries such as India and the United States. The purpose of this study is to evaluate differences in care practices, resources, mortality, and morbidities in preterm infants with birth weight 700 to 1,500 g between two major neonatal centers in these countries. Study Design This is a retrospective cohort study with de-identified data from Fernandez Hospital (FH) in Hyderabad, India, and Texas Children's Hospital (TCH) in Houston, TX, for infants born January 2016 to December 2018, and weighing 700 to 1,500 g at birth. The primary outcome was death before hospital discharge. Results Of 1,195 infants, 736 were admitted to FH and 459 were admitted to TCH. After controlling for differences in gestational age, small for gestational age, and antenatal corticosteroid use, TCH patients had lower mortality before hospital discharge (adjusted odds ratio [aOR] = 0.28, 95% confidence interval [CI]: 0.16–0.48, p Conclusion In this study, TCH infants had decreased odds of death before hospital discharge compared with FH but higher odds of BPD, which may be related to increased survival and differences in care practices. Key Points

Comparison of mortality and major morbidities between very preterm (

Objective: To assess the kidney growth and function in appropriate for date and small for date (SGA) preterm neonates. Methods: Appropriate for date and SGA preterm neonates with gestation