ABSTRACT
Objective: To assess outcomes and factors influencing outcomes in neonates requiringcardiac surgery in India. Methods: This study reports on review of hospital data from atertiary care cardiac surgical institute from January-2009 to December-2015. Results: A totalof 200 neonates were included; of them, 5% of the cases were antenatally diagnosed andmost of them had unmonitored transport (111, 55.5%). The overall mortality rate was 13.5%,(n=27) and 178 (89%) underwent complete defect repair. There was a significant associationof mortality with shock, the number of inotropes, intra-operative procedure, residual lesion,aortic cross-clamp and deep hypothermic circulatory arrest time (all P<0.05). Logisticregression analysis showed ventilation duration, cardiac-bypass time, shock, and residualcardiac lesion as independent predictors of mortality. Conclusion: Cardiac defects werefound to have late detection and most transports were unmonitored. Complete surgical repairand shorter cardiac bypass time can potentially improve neonatal cardiac surgical outcomes
ABSTRACT
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.
ABSTRACT
Health status of neonates in urban slums has not been studied in smaller towns. A questionnaire was administered to 154 families of 10 urban slums of Anand (population - 197351) and 160 families from 6 villages of Anand district. The socioeconomic and education status of the slum dwellers versus rural participants were significantly lower (P<0.001). Antenatal care (79.9 vs 94.4%, P<0.001), hospital delivery (82.5 vs 93.8%, P=0.002), neonatal follow-up (27.9 vs 78.8%, P<0.001), health seeking (56.5 vs 91.3%, P<0.001), essential newborn care and exclusive breastfeeding (6.5 vs 85.6%, P<0.001) were also lower in urban slums, as compared to villages, Care seeking was low in urban slums, Hindus and illiterate mothers. Health care and socioeconomic status of neonates in slums of smaller cities is poorer than in surrounding villages.