Comparison of Sucking Pattern in Premature Infants with Different Feeding Methods.

Objective: To compare the sucking pattern of preterm infants on different feeding methods. Methods: The sucking behavior on a gloved finger was evaluated for infants receiving breastfeeding, spoon-feeding and tube-feeding. Results: The mean (SD) numbers of sucks in spoon-fed infants [49 (20) vs. 35 (23); P=0.04] were significantly higher, and the grade of suck was significantly better compared to the tubefed group. The mean (SD) number of sucks was significantly higher [83 (30) vs. 49 (20), P<0.001] in breastfed infants compared to spoon-fed infants; all infants on breast feeds had grade 2 suction. Conclusion: The sucking behavior varies between tube-fed, spoon-fed, and breastfed preterm infant.

Gestational Age-specific Centile Charts for Anthropometry at Birth for South Indian Infants.

Objective: To construct centile charts for birth weight, length and head circumference for infants born from 24 to 42 weeks of gestation and to compare with the other national and international growth charts. Study design: Observational descriptive study. Subjects: All consecutively live born singleton infants from 24 to 42 weeks of gestation. Methods: Data were retrieved for the birth weight, length and head circumference of infants born from July 1999 to October 2009. Smoothened percentile curves were created separately for the male and female infants by Lambda Mu Sigma (LMS) method. The new curves were compared with the other Indian and international growth charts. Results: Raw and smoothened curves for weight, length and head circumference centiles at birth were created from 31,391 (males: 16,054 and females: 15,337), 28,812, (males: 14,730 and females: 14,082), and 28,790 (males: 14,724 and females: 14,066) infants, respectively. Females infants were lighter than the male infants, especially from 35 weeks onwards. On comparing the study curves with the other Indian growth curves, for infants less than 35 weeks, the mean birth weight for the study infants were similar or lower and for infants greater than 35 weeks, they were higher. On comparison of our weight centiles with the international data, across all gestations and across all centiles, our birth weights are lower. Conclusion: The updated centile charts in this study may be used as reference charts for the birth weight, length and head circumference for the local population. Using earlier growth charts or the Western charts would misclassify the infants at birth into SGA or LGA.

Evaluation of Phototherapy Devices Used for Neonatal Hyperbilirubinemia.

Objective: To compare phototherapy devices based on their physical and photo-biological characteristics viz spectral properties, maximum and mean irradiance, treatable percentage of body surface area, decay of irradiance over time and in vitro photoisomerisation of bilirubin. Design: In vitro experimental study. Setting: Ocular pharmacy laboratory at a tertiary care hospital. Methodology: All the characteristics were measured at a fixed distance of 35 cm from one compact fluorescent lamp (CFL) and three light emitting diode (LED) phototherapy devices in a dark room with an irradiance of <0.1μW/cm2/nm. Estimation of products of in vitro photoisomerisation was done using liquid chromatography - tandem mass spectroscopy (LC-MS/ MS). Results: The emission spectral data were comparable between the phototherapy devices. The devices, however, differed in their maximum irradiance with the spot and indigenous LED units having the highest and lowest values, respectively (56.5 and 16.8μW/cm2/nm). The mean irradiance – measured in 5x5cm grids falling within the silhouette of a term baby – of the spot and improvised LED devices were low (26.8μW/cm2/nm and 11.5μW/cm2/ nm, respectively) possibly due to unevenness in the irradiance of light falling within the silhouette. There was a significant difference in the amount of bilirubin left after exposure to light over a 2-hour time period (% reduction of bilirubin) among the four devices (P=0.001); at 120 minutes after exposure, the amount of bilirubin left was lowest for the CFL (16%) and spot LED (17%) devices and highest for the indigenous LED unit (41%). Conclusions: The four phototherapy devices differed markedly in their physical and photobiological characteristics. Since the efficacy of a device is dependent not only on the maximum irradiance but also on the mean irradiance, rate of decay of irradiance, and treatable surface area of the foot print of light, each phototherapy device should have these parameters verified and confirmed before being launched for widespread use.

Light-emitting Diodes versus Compact Fluorescent Tubes for Phototherapy in Neonatal Jaundice: A Multi-center Randomized Controlled Trial.

Objective: To evaluate whether light-emitting diode (LED) phototherapy is as efficacious as compact fluorescent tube (CFT) phototherapy for the treatment of nonhemolytic jaundice in healthy term and late preterm neonates. Study design: Multi-centre open-label randomized controlled trial. Setting: Four tertiary care neonatal units. Subjects: Healthy term and late preterm neonates with nonhemolytic jaundice. Intervention: Single-surface LED or CFT phototherapy. Primary outcome variable: Duration of phototherapy. Results: A total of 272 neonates were randomized to receive LED (n=142) or CFT (n=130) phototherapy. The baseline demographic and biochemical variables were similar in the two groups. The median duration of phototherapy (IQR) in the two groups was comparable (26 (22-36) h vs. 25(22-36) h; P=0.44). At any time point, a similar proportion of neonates were under phototherapy in the two groups (log-rank test, P=0.38). The rate of fall of serum total bilirubin (STB) during phototherapy and the incidence of ‘failure of phototherapy’ were also not different. An equal proportion of neonates had a rebound increase in STB needing restarting of phototherapy. Side effects were rare, comparable in the two groups and included hypothermia, hyperthermia, rash, skin darkening and dehydration. Conclusions: LED and CFT phototherapy units were equally efficacious in the management of non-hemolytic hyperbilirubinemia in healthy term and late-preterm neonates.

Acute renal failure in neonates.

Acute renal failure (ARF) is a common condition seen in neonatal intensive care units. It is broadly classified into prerenal, intrinsic renal and post renal failure. There is no consensus on the definition of neonatal ARF. Of utmost importance is to differentiate prerenal from intrinsic renal failure. The most common causes of neonatal ARF are hypovolemia, hypotension and, hypoxia. Among several indices that are available for differentiating prerenal failure from intrinsic renal failure, fractional excretion of sodium is the preferred index. Diagnostic fluid challenge with or without frusemide is a bed side method for differentiating prerenal failure from intrinsic renal failure. Babies with ARF have to be monitored for several metabolic derangements like hyponatremia, hyperkalemia, hypocalcemia, and acidosis and have to be managed accordingly. Fluid balance should be precise in order to avoid fluid overload. It is difficult to provide adequate calories due to fluid restriction. Dialysis has to be instituted to preempt complications. Peritoneal dialysis is the easiest and safest modality. These babies need long term follow up as they are prone for long term complications.