Can Clinical Score Be Used to Guide Investigations and Management of Infants Born Through Meconium Stained Amniotic Fluid? A Prospective Observational Study*Sanghvi, Urvi; Diwakar, Krishna Kumar
doi: 10.1177/0973217920921390pmid: N/A
AbstractObjective: To evaluate if Downes– Vidyasagar score (Downes score) for assessing respiratory distress could be used to determine the duration for observation and requirement for investigations like chest X-ray and blood gases, in an infant born through meconium stained amniotic fluid (MSAF).Materials and Methods: Prospective observational study was done in 2 phases—the initial phase to assess the role of the Downes score and the second phase to assess if the conclusions drawn from the initial phase could be applied in clinical practice.Results: In the initial phase, a total of 285 of the 302 infants born through MSAF were included for assessing the role of Downes score. The score reduced with time and did not worsen beyond 6 h. A significant association was noted between Downes score 2 or more at beyond 6 h of life and umbilical cord pH 7.15, higher AaDO2, and chest X-ray suggestive of meconium aspiration syndrome (MAS). In the second phase, applying the criteria of clinical monitoring derived from the initial phase resulted in 75% (110/147) of infants born through MSAF being shifted to the mother’s side by 6 h of life without being subjected to any investigation,Conclusion: Radiological evaluation and blood gas analysis could be restricted to only infants with persistently high or rising Downes score beyond 6 h of life. Infants having a score of <2 by 6 h of life can be shifted to mother’s side, without any further investigations or interventions.
Transports of Sick Neonates to a Tertiary Care Hospital: Condition at Arrival and OutcomesChandrashekhar, Channanayaka; Doreswamy, Srinivasa Murthy; Nataraj, Nanda; Panachiyil, George Mathew; Babu, Tirin
doi: 10.1177/0973217919896210pmid: N/A
AbstractObjective: To evaluate the transport system, condition of the baby on arrival, and the outcome of the sick neonates transported to our hospital.Methodology: This prospective study included 100 neonates referred to our hospital. A pro forma with a questionnaire regarding the transport details was filled with information taken from the parents/attendant accompanying the baby.Results: A total of 100 number of referrals over a period of 8 months were included. Almost half the referrals were in the first week of life: 74% were term and 26% preterm. Only 28% of the babies were sent with prior communication to our hospital. About 69% babies had a referral document of them, but only 26% had complete information regarding the baby’s illness and prior treatment. The modes of transport used were private ambulance (36%), car (25%), and government ambulance (22%). Few newborns were brought by autorickshaw (12%), bus (3%), and two-wheeler (2%) too. None of the babies were brought with kangaroo mother care (KMC) during transit. Intratransport care included supplemental oxygen (53%) and IV medications (14%). On arrival the transported neonates had problems such as prolonged capillary filling time (78%), hypothermia (72%), respiratory distress (23%), hypoglycemia (14%), needing life support (14%), and apnea (8%). Out of them, 85% improved, 12% were discharged against medical advice, 2% died, and 1% referred.Conclusion: The study highlights the unaddressed challenges and the scope for improving the transport of sick neonates between hospitals and further emphasizes the need for devising solutions.
Survey of Point-of-Care Ultrasound Uptake in Indian Neonatal Intensive Care Units: Results and RecommendationsDeshpande, Sujata; Suryawanshi, Pradeep; Sharma, Neha; Maheshwari, Rajesh; Nagpal, Rema; Nagar, Nandini; Gupta, Samir
doi: 10.1177/0973217919897855pmid: N/A
AbstractObjectives: Point-of-care ultrasonography (POCU) refers to the process of ultrasound performed at the bedside by treating physicians, for the ongoing assessment of disease, evaluation of response to treatment, and assistance in procedures. This study was conducted to assess the current utilization, training, and barriers to the implementation of neonatologist-performed POCU (NP-POCU) in Indian neonatal intensive care units (NICUs).Methods: A survey questionnaire was disseminated to practicing neonatologists in India via an online survey tool from July 2017 to September 2017. The questionnaire addressed the information related to the availability of NP-POCU services, indications for its use, perception among neonatologists about its usefulness, training for NP-POCU, and access to pediatric cardiology and radiology services.Results: The overall response rate was 78%. A total of 72% respondents reported having access to NP-POCU services in their units. Neonatologist-performed POCU (NP-POCU) was used most frequently for cranial ultrasound (97%), functional echocardiography (90%), and evaluating line position (67%). Majority (92%) of the units had no training program for NP-POCU. The most common reasons cited for not having NP-POCU services were non-availability of trained personnel to perform POCU (50%) and strict Pre-conception and Prenatal Diagnostic Techniques (PC-PNDT) Act (50%).Conclusions: Neonatologist-performed point-of-care ultrasonography is being increasingly utilized in Indian NICUs. However, there is a lack of structured training and guidelines for its use. Non-availability of trained personnel and strict PC-PNDT Act are major barriers to its implementation. We recommend that accredited training programs and standardized guidelines be established for the safer use of NP-POCU in India.
ABO Incompatibility in the NewbornKimball, Chelsey
doi: 10.1177/0973217919908368pmid: N/A
AbstractABO incompatibility is one form of hemolytic disease of the newborn (HDN). Since the development of antenatal treatment for Rh incompatibility has developed, ABO incompatibility has emerged as the most common cause of HDN. Generally, ABO incompatibility is a benign condition because of the low level of hemolysis that occurs. Infants with ABO incompatibility do require close monitoring and treatment, based on the symptoms. The most common manifestation of ABO incompatibility is hyperbilirubinemia. This hyperbilirubinemia can usually be managed effectively with conventional measures such as phototherapy. However, rare complications such as anemia and, in extreme cases, kernicterus may require blood or exchange transfusion.
Rising Postoperative C-Reactive Protein in Congenital Diaphragmatic Hernia: Sepsis or Inflammation?Mukherjee, Devdeep; Ranganna, Ranganath
doi: 10.1177/0973217919896186pmid: N/A
AbstractThis study aims to determine the incidence of sepsis in neonates operated for congenital diaphragmatic hernia and ascertain if the level or pattern of C-reactive protein (CRP) could be used to differentiate neonates with sepsis from noninfective inflammation. This study suggests that CRP patterns within the first 48-hours after surgical intervention for congenital diaphragmatic hernia could be used to differentiate neonates with noninfective inflammation from sepsis. A larger, multicentric study is needed to differentiate sepsis from inflammation on the basis of CRP rise and thereby help in avoiding unnecessary use of antibiotics.
Threshold Retinopathy of Prematurity with Persistent Corneal DefectNarnaware, Shilpi H.; Bawankule, Prashant K.
doi: 10.1177/0973217919896208pmid: N/A
AbstractAim: A case which highlights the challenges faced in treating a case of type 1 early treatment of retinopathy of prematurity (ETROP) with persistent corneal defect.Case Report: We report a case of a preterm boy born at 28 weeks with birth weight of 700 g who presented with persistent corneal defect along with type 1 ETROP disease. Because of the inability to complete LASER, intravitreal ranibizumab was given as a rescue therapy to buy some time. But unfortunately, baby succumbed to disease because of associated systemic problems.Conclusion: ROP can present with persistent corneal defect which can challenge the treatment of underlying pathology.