Effect of Kangaroo Mother Care Transport in Preventing Moderate Hypothermia in Low Birth Weight Babies During Transportion to Home After Discharge: A Randomized Controlled Trial

Background: Transport of neonates is often neglected, which results in high mortality of neonates during transport. Objective: To determine the effectiveness of kangaroo mother care (KMC) in terms of hypothermia prevention during transport from hospital to home for low birth weight neonates. Study design: Randomized controlled trial. Participants: A total of 152 low birth weight neonates being discharged from the neonatal intensive care unit of our hospital between March, 2021 and August, 2022. Intervention: Neonates in the study group (n=76) received KMC during transport from the hospital to home, while the control group (n=76) did not receive KMC during transport. Axillary temperature was recorded in both groups at the time of discharge, every 5 minutes during transport, and on reaching home. Outcomes: Hypothermia episodes in neonates while receiving KMC compared to neonates not receiving KMC. Results: Primary endpoint of the study was moderate hypothermia. During transport, 23 (30.3%) neonates in the control group experienced moderate hypothermia during transport, which was statistically significant [0% vs 30.3%; P<0.001]. From 10 minutes of transport till the neonates reached home, the mean (SD) temperature in the study group was significantly higher than in the control group [ 36.8 (0.23) °C vs 36.6 (0.3) °C; P<0.001] at time 15 minutes. Similar results were noted in preterm neonates [36.7 (0.25) °C vs 36.5 (0.29) °C; P<0.001] at time 15 minutes. The number of hypothermia episodes was more in the control group than in the study group during most of the transport time [7.6% vs 43.2%; P<0.001] at time 15 minutes. Conclusions: Low birth weight neonates receiving KMC showed optimal thermoregulation, whereas a high incidence of moderate hypothermia was seen among neonates receiving conventional care during transport.

Effect of Kangaroo Mother Care on Cerebral Hemodynamics in Preterm Neonates Assessed by Transcranial Doppler Sonography in Middle Cerebral Artery

Objective: To study the effect of KMC in premature newborns on cerebral hemodynamics in the middle cerebral artery (MCA) using transcranial doppler sonography. Methods: In this descriptive study, 40 clinically stable preterm neonates admitted to the neonatal intensive care unit of our institute and undergoing Kangaroo mother care (KMC) were enrolled. Physiological and cerebral blood flow parameters of MCA were obtained by using transcranial doppler sonography at baseline, at 60 minutes of KMC, and after 60 minutes of stopping KMC. Results: Of the 40 enrolled neonates (24 males), the mean (SD) birth weight, gestation age, and postnatal age were 1698.25 (495.44) g, 33.00 (1.67) wk, and 6.80 (4.51) days, respectively. The mean (SD) cerebral blood flow velocities increased (peak systolic velocity (PSV), P=0.03; end diastolic velocity, P<0.001; mean velocity, P<0.001) and doppler indices decreased (resistive index, P=0.001; pulsatility index, P<0.001) significantly; whereas, heart rate (P<0.001) decreased but SpO2 (P=0.001) and mean blood pressure (P=0.003) increased significantly at 60 minutes of KMC as compared to baseline. Sixty minutes after stopping KMC, all parameters (except PSV) were higher than baseline, indicating post KMC effect. Conclusion: KMC improves cerebral hemodynamics in clinically stable preterm neonates.

Pain Control Interventions in Preterm Neonates: A Randomized Controlled Trial

Objectives: To compare individual efficacy and additive effects ofpain control interventions in preterm neonates.Design: Randomized controlled trialSetting: Level-3 University affiliated neonatal intensive care unit.Participants: 200 neonates (26-36 wk gestational age) requiringheel-prick for bedside glucose assessment. Exclusion criteriawere neurologic impairment and critical illness precluding studyinterventions.Intervention: Neonates were randomly assigned to Kangaroomother care with Music therapy, Music therapy, Kangaroo Mothercare or Control (no additional intervention) groups. All groupsreceived expressed breast milk with cup and spoon as a baselinepain control intervention.Main outcome measure: Assessment of pain using PrematureInfant Pain Profile (PIPP) score on recorded videos.Results: The mean (SD) birth weight and gestational age of theneonates was 1.9 (0.3) kg and 34 (2.3) wk, respectively. Analysisof variance showed significant difference in total PIPP scoreacross groups (P<0.001). Post-hoc comparisons using Sheffe’stest revealed that the mean (SD) total PIPP score wassignificantly lower in Kangaroo mother care group [7.7 (3.9) vs.11.5 (3.4), 95% CI(–5.9, –1.7), P<0.001] as well as Kangaroomother care with Music therapy group [8.5 (3.2) vs. 11.5 (3.4),95%CI (–5.1, –0.9), P=0.001] as compared to Control group.PIPP score was not significantly different between Control groupand Music therapy group.Conclusions: Kangaroo mother care with and without Musictherapy (with expressed breast milk) significantly reduces pain onheel-prick as compared to expressed breast milk alone. Kangaroomother care with expressed breast milk should be the first choiceas a method for pain control in preterm neonates.

Oral Sucrose for Pain in Neonates During Echocardiography: A Randomized Controlled Trial.

Objectives: To test the efficacy of oral sucrose in reducing pain/ stress during echocardiography as estimated by Premature Infant Pain Profile score. Design: Double-blind, parallel-group, randomized control trial. Setting: Tertiary-care neonatal care unit located in Western India. Participants: Neonates with established enteral feeding, not on any respiratory support and with gestational age between 32 and 42 weeks requiring echocardiography. Interventions: Neonates in intervention group received oral sucrose prior to echocardiography. Main outcome measures: Assessment was done using Premature Infant Pain Profile score. Results: There were 104 examinations; 52 in each group. Baseline characteristics like mean gestational age (37.6 vs. 37.1), birth weight (2.20 vs. 2.08), and feeding status (Breastfeeding- 59.6% vs. 44.2%, paladai feeding- 13.5% vs. 13.5%, and gavage feeding- 26.9% vs. 42.3%) were comparable. The mean (SD) premature infant pain profile score was significantly higher in control group [(7.4 (3.78) vs. 5.2 (1.92), P <0.001]. Conclusion: Oral sucrose significantly reduces pain, and is safe to administer to neonates.

Effect of skin to skin care to neonates on pulse rate, respiratory rate, SPO2 and blood pressure in mothers.

Physiological benefits of skin to skin care (STS) to newborns are known but there is scarcity of data on changes in physiological parameters like pulse rate, respiratory rate, SPO2 and blood pressure in mothers during STS. We hypothesize that STS is beneficial to mothers with respect to these parameters. Objective of this study was to assess the changes of these parameters in mothers while providing STS for one hour. STS was provided by 52 mothers for a total of 127 times and parameters were recorded at starting of STS, at 15 min, at 30 min, at 60 min of STS and at 5 min rest after stopping STS. There were no significant changes in pulse rate and SPO2 but blood pressure and respiratory rate reduced significantly during STS as compared to rest after stopping STS. Thus STS is physiologically beneficial to mothers.

Point of Care Ultrasonography for Position of tip of Endotracheal Tube in Neonates.

Objective: To compare ultrasonography with chest radiograph to detect the level of endotracheal tube tip in intubated neonates. Design: Observational. Setting: Neonatal care unit of a teaching hospital. Participants: 53 neonates selected by convenience sampling. Intervention: Ultrasonography of chest was done with probe of 5 to 8 MHz using high parasternal view. The distance of the endotracheal tube tip to the arch of aorta on ultrasonography was compared with level of endotracheal tube tip in radiograph. Primary Outcome: Distance of endotracheal tube tip from the upper border of the arch of aorta on ultrasonography. Results: Endotracheal tube tip was visualised on ultrasonography within 0.5 - 1.0 cm distance from upper border of arch of aorta in 48 out of 53 neonates. This corresponded with the normal position of endotracheal tip in radiograph at T2 to T3. In 5 neonates, endotracheal tube tip was not visualized on ultrasonography and in all these newborns it was at higher level in radiograph. Conclusions: Distance of endotracheal tip to arch of aorta as measured on ultrasonography is helpful in early identification of the level of endotracheal tube tip.

Comparison of Forehead Infrared Thermometry with Axillary Digital Thermometry in Neonates.

Fluctuations in core body temperature beyond a narrow range are of concern as they indicate changed homeostasis. Thermoregulation remains a key aspect of neonatal care. New ‘non touch’ method of measuring temperature may reduce infection rate and discomfort of neonates. Body temperature of neonates admitted in Neonatal Intensive Care Unit was measured using axillary digital thermometer and a handheld infrared non touch thermometer. The two methods did not agree well (mean difference = -0.5, 95% limits of agreement: [-2.3, 1.2]). The agreement was similar with a negligible difference when patients in open care warmers were excluded (mean difference = -0.6, 95% limits of agreement: [-2.3, 1.1]). As the accuracy is unsatisfactory, the said technology needs further improvement before it can be adapted for routine patient care.