Achieving Early Mother-baby Skin-to-skin Contact in Caesarean Section: A Quality Improvement Initiative

Objective: To improve rate of skin-to-skin contact for earlyinitiation of breastfeeding at birth on operation table amonghealthy term and late pretem babies born by caesarean sectionsfrom 0% to 80% in eight weeks.Methods: A quality improvement initiative was undertaken atmaternity-newborn care unit of a tertiary-care hospital. A teaminvolving Neonatologists/Pediatricians, Obstetricians,Anaesthesiologists, and Nurses in concerned areas identifiedproblem areas using Fish bone analysis. Situational analysis wasdone through process flow mapping. Three Plan-do-study-actcyles were undertaken. Firstly, sensitization of personnel wasdone and a written policy was made. Secondly, maternalcounselling and procedural modifications were done. Lastly,efforts were made to improve duration of contact.Results: Rate of earlyskin-to-skin contact after Plan-do-study-act cycle 1, 2 and 3, respectively was 87.5%, 90% and 83.3%. Itwas 100% after sustainability phase after four months.Conclusion: Early skin-to-skin contact was achievable throughsensitization of all persons involved and simple proceduralchanges. Prolonging duration of contact remained a challenge.

Comparison of respiratory quotient and resting energy expenditure in two regimens of enteral feeding - continuous vs. intermittent in head-injured critically ill patients

Measurement of respiratory quotient [RQ] and resting energy expenditure [REE] has been shown to be helpful in designing nutritional regimens. There is a paucity of the literature describing the impact of a feeding regimen on the energy expenditure patterns. Therefore, we studied the effect of continuous vs. intermittent feeding regimen in head-injured patients on mechanical ventilation on RQ and REE After institutional ethical approval, this randomized study was conducted in 40 adult male patients with head injury requiring controlled mode of ventilation. Patients were randomly allocated into two groups. Group C: Feeds [30 kcal/kg/day] were given for 18 h/day, with night rest for 6 h. Group I: Six bolus feeds [30 kcal/kg/day] were given three hourly for 18 h with night rest for 6 h. RQ and REE were recorded every 30 min for 24 h. Blood sugar was measured 4 hourly. Other adverse effects such as feed intolerance, aspiration were noted. Demographic profile and SOFA score were comparable in the two groups. Base line RQ [0.8 vs. 0.86] and REE [1527 vs. 1599 kcal/day] were comparable in both the groups [P>0.05]. RQ was comparable in both groups during the study period at any time of the day [P>0.05]. Base line RQ was compared with all other RQ values measured every half hour and fluctuation from the base line value was insignificant in both groups [P>0.05]. REE was comparable in both the groups throughout the study period [P>0.5]. Adequacy of feeding as assessed by EI/MREE was 105.7% and 105.3% in group C and group I, respectively. There was no significant difference in the blood sugar levels between the two groups [P>0.05]. We found from our study that RQ, REE, and blood sugar remain comparable with two regimens of enteral feeding - continuous vs. intermittent in neurosurgical patients on ventilator support in a ICU setup