Journal of Neonatology

K, Bhavana; Kallimath, Aditya; Malshe, Nandini; Lalwani, Sanjay

doi: 10.1177/09732179261455550pmid: N/A

BackgroundIntraventricular hemorrhage (IVH) is the most common intracranial bleeding in preterm neonates and is linked to significant long-term neurodevelopmental morbidity. Routine cranial ultrasound (cUSG) screening recommendations, along with data on IVH prevalence and risk factors in India—especially in late preterm infants—are limited.ObjectivesThis study aimed to determine IVH prevalence across preterm gestational ages (<37 weeks), identify maternal and neonatal risk factors for IVH, and evaluate IVH burden in late preterms in a tertiary care neonatal intensive care unit in Western Maharashtra.MethodsIn this single-center, prospective observational study from December 2020 to February 2022, 421 preterm neonates admitted within 24 h of birth received cUSG between days 4 and 7 of life. IVH was graded using the Papile classification. Maternal and neonatal data were collected via standardized forms. IVH prevalence was calculated, and univariate and multivariate logistic regression analyses identified independent risk factors. Late preterm infants (34-36 + 6 weeks) were analyzed separately.ResultsOf 421 preterm neonates, overall IVH prevalence was 28.27%, highest in those <28 weeks (62.5%) and birth weight <1,000 g (55.1%). IVH grades were: I (14.7%), II (10.7%), III (2.1%), IV (0.7%); 6.7% had other central nervous system abnormalities. Multivariate analysis showed weight (adjusted OR 2.13; 95% CI 1.27-3.56; P = .004), mechanical ventilation (adjusted OR 2.10; 95% CI 1.15-3.84; P = .016), and early-onset sepsis (adjusted OR 1.81; 95% CI 1.07-3.08; P = .027) as independent predictors. In late preterm neonates (n = 233), IVH prevalence was 19.3%, with birth weight <1,500 g (adjusted OR 5.35; 95% CI 1.90-15.07; P = .002) and mechanical ventilation (adjusted OR 3.21; 95% CI 1.24-8.31; P = .016) as independent risk factors.ConclusionsIVH is a major complication across preterm ages, affecting nearly one-fifth of late preterm infants. Prevalence in <32 weeks neonates matches that of developed countries. Low birth weight, mechanical ventilation, and early sepsis heighten risk. Routine cUSG screening should include late preterm neonates, and preventing hemodynamic instability and sepsis could reduce IVH and neurodevelopmental issues.

Keerthidarshini, ; Wari, Prakash K.; Ratageri, Vinod H.; Meghana, ; Manasa,

doi: 10.1177/09732179261423802pmid: N/A

BackgroundMother’s own milk is the optimal source of neonatal nutrition. When maternal milk is unavailable or insufficient, pasteurized donor human milk (DHM) is recommended for high-risk and low-birth-weight infants and is associated with a lower risk of necrotizing enterocolitis compared with formula.ObjectiveTo evaluate the impact of establishing a DHM bank on feeding practices and early outcomes in a tertiary neonatal unit in North Karnataka.MethodsThis retrospective before-and-after cohort study included inborn neonates admitted during the 12 months before and after milk bank establishment. Primary outcomes were time to initiation of enteral feeds and time to achievement of full enteral feeds. Secondary outcomes included DHM use, formula exposure, exclusive human-milk feeding at discharge, and feeding practices at early follow-up.ResultsOf 267 neonates screened, 260 were eligible (130 per epoch). After milk bank implementation, DHM use increased (113 vs. 79; P < .001) and formula exposure declined (4 vs. 21; P < .05). Mean time to first enteral feed reduced significantly (3.0 ± 3.7 vs. 10.3 ± 13.1 h; P < .001), as did time to full feeds (3.2 ± 4.4 vs. 4.0 ± 7.6 days; P = .04). Exclusive human-milk feeding rates improved at discharge (P < .001) and remained higher at early follow-up (P = .0016).ConclusionsEstablishment of a DHM bank facilitated earlier enteral feeding, reduced formula exposure, and strengthened exclusive breastfeeding practices, supporting its role as an effective strategy to improve neonatal nutrition in resource-limited settings.

Panigrahi, Nikita; A, Venkatesh Harohalli; Kannur, Netra S; Pejaver, Rajath; N, Karthik Nagesh; Raman, E.V.

doi: 10.1177/09732179261428867pmid: N/A

IntroductionUpper airway pathology is an important cause of neonatal respiratory distress, presenting either as acute, life-threatening obstruction requiring immediate intervention or as a chronic, indolent condition, depending on severity and anatomical level. Laryngomalacia is the most common etiology, usually managed conservatively, but sometimes requiring surgery, while high-grade laryngeal clefts pose major therapeutic challenges. This study aimed to evaluate the incidence of laryngoscope-confirmed upper airway pathologies in neonates admitted with suspected airway involvement.Materials and MethodsWe conducted a retrospective cohort study of neonates admitted to a tertiary neonatal intensive care unit (NICU) over 3 years with suspected upper airway pathology warranting endoscopic evaluation by flexible fiberoptic laryngoscopy (FFL). Descriptive statistics were applied. Cases managed conservatively were followed using the SPECS algorithm (Severity, Progression, Eating difficulty, Cyanosis, Sleep disturbance), with re-evaluation as indicated.ResultsOf the neonates with respiratory distress, 37 (8.2%) underwent FFL for suspected airway pathology. Twelve (32%) had bedside procedures, while 25 (68%) underwent evaluation in the operating theater (OT). The median procedure time was 15 min (range 10-30), with no reported complications. The most frequent diagnoses were laryngomalacia (24.3%), subglottic stenosis (13.5%), and laryngeal cleft (8%). Among laryngomalacia cases, 67% required surgical correction.ConclusionFlexible airway endoscopy is a safe and effective diagnostic tool for neonatal airway obstruction and should be employed in all cases of suspected pathology to identify correctable causes. Laryngomalacia emerged as the most prevalent condition, frequently requiring intervention.

Nagula, Karthikeya; Vadije, Praveen Rao; Sree, Vijaya; Subramanian, Sreeram; Murki, Anuradha; Murki, Srinivas

doi: 10.1177/09732179261435807pmid: N/A

BackgroundProviding mother’s own milk (MOM) for very low birth weight (VLBW) neonates, especially in outborn settings, is challenging due to factors such as mother–infant separation, communication gaps and limited breastfeeding support at referring hospitals.MethodsThis quality improvement initiative used the Point of Care Quality Improvement (POCQI) framework, with sequential Plan–Do–Study–Act (PDSA) cycles to increase MOM volume in mothers of VLBW neonates. This study was conducted in three phases—baseline, intervention and sustenance—from August 2022 to July 2023. Each phase enrolled different mother–infant dyads (non-concurrent cohorts), and outcomes were compared across phases. We aimed to increase cumulative MOM over postnatal days 1-14 by 25% during a 1-year implementation period using sequential PDSA cycles. Interventions included lactation education, a standard operating procedure for lactation counselling, provision of free manual breast pumps and a short course of domperidone.ResultsAmong 48 mother–infant dyads, cumulative MOM (median [IQR]) increased from 1,105 mL (281-2,680) at baseline to 2,847 mL (1,912-3,170) in the sustenance phase. This increase reflects between-phase cohort comparisons and does not represent within-mother longitudinal improvement. Across phases, median daily MOM approached the infant feeding volume by day 3 and exceeded it from day 7 onwards. Exclusive breastfeeding at discharge improved from 50% (5/10) at baseline to 87.5% (7/8) in the sustenance phase, though not statistically significant (P = .24).ConclusionUsing the POCQI framework with sequential PDSA cycles, higher MOM volumes were observed across successive phases in our predominantly outborn VLBW population; interpretation of sustainability is limited by the small sustenance cohort (n = 8).

doi: 10.1177/09732179261448387pmid: N/A

Bhat, Irfan Bashir; Rahul, Aswathy; Thankam, Uma; Sujatha, Radhika; Padman, Athul

doi: 10.1177/09732179261421826pmid: N/A

BackgroundFor non-vigorous neonates ≥29 weeks of gestation, there is no consensus on the preferred cord management strategy.ObjectiveTo compare the need for cardiorespiratory support within the first 24 h of life, hematocrit at 48 h, and the requirement of phototherapy within the first week between non-vigorous neonates ≥29 weeks’ gestation receiving intact umbilical cord milking (I-UCM) and those receiving early cord clamping (ECC).MethodsThis prospective observational study was conducted in a tertiary care medical college between October 2023 and March 2025. Non-vigorous neonates ≥29 weeks’ gestation were categorized into I-UCM and ECC groups on the basis of umbilical cord management, which was decided by the lead obstetrician as per their preference.ResultsNinety-six neonates were enrolled, 48 in each group. Neonates in the I-UCM group required significantly less inotropic support than the ECC group (RR: 0.52; 95% CI: 0.29-0.92), with the greatest benefit in those <34 weeks’ gestation (RR: 0.29; 95% CI: 0.10-0.92). The overall need for respiratory support was comparable, but invasive ventilation was less frequent with I-UCM (45% vs. 57.9%), though not statistically significant. Hematocrit at 48 h was higher in the I-UCM group (57.0% vs. 53.8%; P < .05). No significant difference was observed in the need for phototherapy.ConclusionI-UCM in non-vigorous neonates ≥29 weeks’ gestation reduced the need for inotropes within the first 24 h of life and improved early hematocrit when compared to ECC.

doi: 10.1177/09732179261448676pmid: N/A

doi: 10.1177/09732179261448718pmid: N/A

Jain, Smrati; Srivastava, Akanksha D.; Verma, Ashish

doi: 10.1177/09732179261423800pmid: N/A

BackgroundNeonatal sepsis attributable to Candida species represents a significant contributor to morbidity and mortality within neonatal intensive care units (NICUs). The emergence of non-albicans Candida (NAC) species, coupled with heightened antifungal resistance and frequent involvement of multiple organ systems, presents novel therapeutic challenges, particularly in resource-constrained environments.MethodsThis prospective observational study was executed in the NICU of a tertiary care center at Lucknow, from January 2023 to July 2024. Neonates exhibiting symptoms suggestive of sepsis were meticulously screened, and those with culture-confirmed Candida infections (from blood, cerebrospinal fluid, or urine) were incorporated into the study. Clinical manifestations, risk factors, species distribution, antifungal susceptibility, organ involvement, and outcomes were systematically analyzed.ResultsAmong 1,356 NICU admissions, 596 neonates were assessed for sepsis, with 62 (4.57%) yielding positive cultures for Candida. The mean gestational age of affected neonates was 34.63 ± 4.50 weeks, and the mean birth weight was 1,970.48 ± 974.77 g. A majority were preterm (53.2%) and low birth weight (<2,500 g; 67.7%), confirming the inverse association between gestational maturity, birth weight, and risk of invasive Candida infection. NAC species comprised 85.9% of the isolates, with C. tropicalis (23.4%) and C. utilis (20.3%) being the most prevalent. Multiple organ involvement was documented in 16.1% of neonates, with the renal (14.5%) and pulmonary (19.3%) systems being the most frequently affected. Resistance to fluconazole was observed in 37.5% of cases, whereas caspofungin exhibited 100% sensitivity. The overall mortality rate was 14.6%, with C. auris disproportionately contributing to fatalities.ConclusionNeonatal Candida sepsis is increasingly characterized by non-albicans species, marked by considerable antifungal resistance and frequent organ involvement. Prompt suspicion, systematic organ screening, and species-specific antifungal therapy are imperative in mitigating mortality rates.

Rooprai, Parminder Singh; Gupta, Divya; Yadav, Raj Kumar

doi: 10.1177/09732179261451043pmid: N/A

The transition from orogastric feeds to independent oral feeds is a giant leap for a preterm neonate, especially for an extremely preterm neonate. These neonates have an immature neuronal control, weak oral musculature, and poor coordination of sucking, swallowing and respiration. Oromotor stimulation (OMS) techniques are helpful for such neonates by increasing oral muscle tone, improving coordination of sucking and swallowing, and enhancing overall feeding performance. Amongst the many techniques, the preterm infant oromotor intervention is the most popular and widely researched technique. Despite growing evidence of its benefits, OMS techniques suffer from serious limitations such as the need for specialised healthcare professionals for the intervention, uncertainty about the appropriate duration, frequency and appropriate gestational age for initiation of the intervention, along with a lack of robust evidence regarding its overall benefits, which has limited wider confidence and routine implementation of this technique in neonatal units nationwide. Despite its present limitations, OMS has strong potential and is likely to be of great benefit for a specific group of neonates, such as those on prolonged ventilatory support and with other complications.