Normative Data of Optimally Placed Endotracheal Tube by Point-of-care Ultrasound in Neonates

Objective: To derive normative data of the distance betweenoptimally placed endotracheal tube tip and arch of aorta byultrasound in neonates across different weight and gestation.Design: Cross-sectional study.Setting: Tertiary care neonatal intensive care unit from April 2015to May 2016.Participants: All neonates requiring endotracheal intubation wereeligible for the study.Methods: During intubation, insertional length was determinedusing weight-based formula. The distance between endotrachealtube tip and arch of aorta was measured by ultrasound.Endotracheal tube position was confirmed by chest radiograph.Results: Out of 133 enrolled infants, 101 (75.9%) had optimallyplaced endotracheal tubes. The mean (SD) distance betweenendotracheal tube tip and arch of aorta by ultrasound was 0.78(0.21) cm in infants <1500 g and 1.04 (0.32) cm in infants ≥1500 g.The regression equation to estimate insertional length fromweight, crown heel length (CHL), occipito-frontal circumference(OFC), nasal tragus length (NTL) and sternal length (SL) wereWt(kg)+4.95, 0.15×CHL(cm)+0.57, 0.22×OFC(cm)+0.49, 0.82×NTL(cm)+1.24 and 0.75×SL(cm)+2.26, respectively.Conclusion: Our study reports normative data of the distancebetween optimally placed endotracheal tube tip and arch of aortaby ultrasound in neonates. The distance between endotrachealtube tip and arch of aorta increases with increase in weight andgestation. Insertional length correlates strongly with all theanthropometric parameters

Impact of Quality Improvement Program on Expressed Breastmilk Usage in Very Low Birth Weight Infants

Objective: To improve the usage of expressed breast milk invery low birth weight infants admitted in the neonatal intensivecare unit of a tertiary centre in India.Methods: Between April 2015 and August 2016, various Plan-do-act-study cycles were conducted to test change ideas likeantenatal counselling including help of brochure and video, post-natal telephonic reminders within 4-6 hours of birth,standardization of Kangaroo mother care, and non-nutritivesucking protocol. Data was analyzed using statistical processcontrol charts.Results: 156 very low birth weight infants were deliveredduring the study period, of which 31 were excluded due tovarious reasons. Within 6 months of implementation, theproportion of very low birth weight infants who receivedexpressed breast milk within 48 hours improved to 100% from38.7% and this was sustained at 100% for next 8 months. Themean time of availability and volume of expressed breast milkwithin 48 hours, improved gradually from 73.3 h to 20.9 h and 4.7mL to 15.8 mL, respectively. The mean proportion of expressedbreast milk once infant reached a feed volume of 100 mL/kg/dayalso improved from 61.3% to 82.3%.Conclusion: Quality improvement interventions showedpromising results of increased expressed breast milk usage invery low birth weight infants.

Growth of Very Low Birth-Weight Indian Infants During Hospital Stay.

Objectives: To evaluate the growth pattern of Very Low Birth Weight (VLBW) infants (birthweight <1500g) during hospital stay and to compare the growth of Small for gestational age (SGA) and Appropriate for gestational age (AGA) infants. Study design: Prospective observational study. Setting. Level III Neonatal Intensive Care Unit (NICU) in Northern India. Participants: A cohort of 97 VLBW infants, admitted to NICU at Sir Ganga Ram Hospital, from 1 January, 2007 to 31 July, 2008. Intervention/Measurement: Weight, length and head circumference (HC) were serially measured from birth till discharge and respective Z scores were calculated as per data from Fenton’s references. Growth was also assessed by superimposing these trends on Ehrenkranz’s postnatal growth charts. Results: The mean Z scores for weight, length and HC at birth were –1.17, –1.09 and –0.54, respectively. These decreased to –2.16, –2.24 and –1.35, respectively by discharge. Both SGA and AGA infants exhibited a decrease of approximately 1 Z score in all parameters. On postnatal charts, growth of infants remained at or above respective reference lines, except in those below 1000g at birth. Average daily weight gain after regaining birth weight was 15.18 ± 1.7 g/kg/d, whereas the increase in HC and length were 0.48 ± 0.2 cm/week and 0.60 ± 0.4 cm/week, respectively. These increments when compared to the intrauterine growth rates, indicated discrepant growth trends. Conclusions: VLBW infants suffered significant growth lag during NICU stay and exhibited disproportionately slow growth of HC and length.

Mutation studies in x-linked myotubular myopathy in three indian families.

Congenital myopathies are a group of genetic disorders characterized by generalised muscle hypotonia and weakness of varying severity. They are distinct entities and do not include muscular dystrophies, metabolic myopathies and mitochondrial disorders. Myotubular myopathy is a rare sub type within this group of disorders. Clinical differentiation of the various types is difficult and requires muscle biopsy with histopathological and immunohistochemical studies for specific diagnosis. Gene studies are a prerequisite for genetic counseling adn prenatal diagnosis. Here presented three cases of X-linked myotubular myopathy in three Indian families where the diagnosis was established by mutation analysis in the MTM1 gene in all, and supported his histopathology in two. All three families had history of previous male neontal deaths with similar complaints. Molecular analysis revealed hemizygous mutations in the MTM1 gene including c.1261-10A>G in case, 1, c.70C>T (R24X) in case 2, and a previously unreported mutation, c.924_926delCTT(p. F308del), in case 3. Genetic counseling was performed regarding the X-linked inheritance, their 50% risk of recurrence in boys in subsequent pregnancies, and a feasibility of prenatal diagnosis. This is the first report of cases of X-linked Myotubular myopathy from India.