A randomized control trial of hypothermia alert device in low birth weight newborns and the effect on kangaroo mother care and weight gain

Background: Lack of thermal protection is one of the major challenges faced by developing nations for newborn survival. Early detection and subsequent prevention of hypothermia through Kangaroo Care could lead to significant health outcomes for the newborn. Hypothermia alert device is a bracelet that monitors for early hypothermia by sensing the extremities and sounding an alarm for parents to take action.Methods: In a randomized controlled trial, the effect of the hypothermia alert device on KMC compliance at home and weight gain of newborns on 4th week follow-up was evaluated. New borns discharged from the neonatal intensive care unit at Indira Gandhi Institute of Child Health (IGICH). Neonates who were LBW (less than 2500 grams) were included in the study once they were stable and ready for discharge. Neonates were given a hypothermia alert device to monitor their temperatures for hypothermia for 4 weeks. Weekly follow-ups were held with parents and to record measurements of growth. Additionally, parents were given a KMC diary to track sessions of KMC. Neonates were given either a placebo bracelet or a BEMPU Bracelet. Bracelets were identical and both monitored for hypothermia, however only the BEMPU Bracelet gave an alarm when the newborn was hypothermic.Results: Statistically 44 neonates completed the 4-week trial; 23 were in the control group and 21 were in the BEMPU group; of these, 19 participants in the control group completed KMC diaries and 19 BEMPU group completed KMC diaries. The results of the clinical trial reveal that parents of neonates in the BEMPU group demonstrated better compliance to KMC. In the BEMPU group, the average daily time spent doing KMC was significantly higher in first (3.02 v 1.96 h, p=0.016) and fourth (3.04 v 2.38 h, p=0.094) week of discharge. There was an increase of weight gain in the BEMPU group after the first (25.7 v 20.7 g, p=0.1.85) and fourth (28.3 v 22.9 g, p=0.057) week of discharge.Conclusions: The hypothermia alert device was found to be an effective intervention to promote parent adherence to Kangaroo Care and weight gain.

Levetiracetam versus Phenobarbitone in Neonatal Seizures –A Randomized Controlled Trial

Objective: To compare the efficacy and safety of intravenous Levetiracetam andPhenobarbitone in the treatment of neonatal seizures. Design: Open labelled, Randomizedcontrolled trial. Setting: Level III Neonatal Intensive Care Unit (NICU). Participants: 100neonates (0-28 days) with clinical seizures. Intervention: If seizures persisted even aftercorrection of hypoglycemia and hypocalcemia, participants were randomized to receive eitherLevetiracetam (20 mg/kg) or Phenobarbitone (20 mg/kg) intravenously. The dose of samedrug was repeated if seizures persisted (20 mg/kg of Levetiracetam or 10 mg/kg ofPhenobarbitone) and changeover to other drug occurred if the seizures persisted even aftersecond dose of same drug. Main outcome measures: Cessation of seizures with one or twodoses of the first drug, and remaining seizure-free for the next 24 hours. Results: Seizuresstoped in 43 (86%) and 31 (62%) neonates in Levetiracetam and Phenobarbitone group,respectively (RR 0.37; 95%CI 0.17, 0.80, P<0.01). 10 neonates had adverse reactions in thephenobarbitone group (hypotension in 5, bradycardia in 3 and requirement of mechanicalventilation in 2 neonates) while none had any adverse reaction in Levetiracatam group.Conclusion: Levetiracetam achieves better control than Phenobarbitone for neonatalseizures when used as first-line antiepileptic drug, and is not associated with adverse drugreactions.

Retinopathy of Prematurity –Promising Newer Modalities of Treatment.

Retinopathy of prematurity (ROP) is a disorder of neonatal retinal vascularization. The incidence is increasing in developing countries like India in view of the rising numbers of preterm deliveries and improved neonatal care. Traditional modalities of treatment included cryotherapy and laser therapy, which were laborious and required special training. Hence, research is on way to find novel treatment modalities directed at various levels of pathogenesis for this blinding disease. We reviewed the published and unpublished literature on newer methods of ROP management. The pathogenesis of ROP has been studied with respect to the mediators of angiogenesis. Anti vascular endothelial growth factor (Anti-VEGF) therapy has been extensively studied and the studies have demonstrated its promising role early stages of ROP. The role of Insulin like growth factor (IGF), Granulocyte colony stimulating factor (GCSF), and June kinases (JNK) inhibitors are being studied by various researchers across the world. Gene therapy holds promise in the reversal of ROP changes.