Retinopathy of prematurity in preterm babies in a local medical college and hospital

Background: Retinopathy of prematurity is a multifactorial vasoproliferative retinal disease that increases in incidence with decreasing gestational age and is one of the leading causes of preventable childhood blindness in India. Advances in neonatology have led to dramatic increase in survival of preterm neonates and in turn, to the risk of developing ROP. Since most of the risk factors associated with ROP mentioned above arise in the neonatal intensive care unit (NICU) itself and most of them are avoidable, cautious monitoring of the risk factors, early screening, follow up and surgical intervention have been shown to reduce the incidence and improve the outcome of ROP.Methods: This was a prospective observational study conducted for a period of 2 years. A total of 151 infants admitted in NICU /SNCU who satisfied the inclusion criteria were enrolled in this study. Initial and follow up screening was conducted in three phases the results were documented in proforma after ethical clearance.Results: Comparison of risk factors between eyes with and without ROP was done using Chi-square test. A p-value of<0.05 was considered to be statistically significant. Incidence of ROP in centre is found to be 33.8%. Among maternal risk factors, multiple gestation and PROM/PPROM is found to be significant in the development of ROP from this study. However, mode of delivery and gestational hypertension, were found to be not significant in ROP. Among neonatal risk factors, low birth weight, lower gestational age, prolonged oxygen exposure, blood transfusion, mechanical ventilation, sepsis, phototherapy was found to be significant in this study.Conclusions: ROP, being an emerging cause for potentially blinding visual disability, needs to be diagnosed early. Due to the advancements in neonatology and better survival of preterm babies, timely screening, regular follow up, early detection and intervention is mandatory. A multidisciplinary approach is required in diagnosis and treatment of the disease. Proper counselling and motivation for parents of preterm and low birth weight babies for regular follow up is also essential.

Associations between maternal responsiveness due to the number of offspring and motor development / Associações entre responsividade materna em função da prole e desenvolvimento motor / Asociaciones entre la responsividad maternal en función de la descendencia y desarrollo motor

Maternal responsiveness (MR) is a predictor of the acquisition of motor skills by premature infants. This study aimed to verify associations between MR due to the number of offspring and motor development (MD) in preterm infants. Eighteen dyads participated in this study, divided into three groups: primiparous mothers with twin newborns (PMT), primiparous mothers (PM), and multiparous mothers (MM). Medical Records, the Social Interaction Scale (SIS), and a Motor Development Observation Protocol were used. In the Adaptive Fine Motor Development (AFMD), the PMT group presented more frequent "normal" outcomes (5; 83.3%), with a mean score of 13.2 points in the SIS (p < 0.0001). For those that evolved with "risk," in both AFMD and gross motor development (GMD), the MM group stood out (4; 66.7%), presenting a mean SIS score of 12.1 (p < 0.0001). The MR quality as a function of the offspring number is associated with AFMD and GMD of premature infants in the first year of life.

A responsividade materna (RM) é um preditor da aquisição de habilidades motoras de prematuros. O objetivo deste estudo foi verificar associações entre a RM e o desenvolvimento motor (DM) de prematuros em função do tamanho da prole. Participaram 18 díades, distribuídas em três grupos: mães primíparas e neonatos gemelares (MPG), mães primíparas (MP) e mães multíparas (MM). Utilizaram-se ficha clínica, Escala de Interação Social (EIS) e Protocolo de Observação do DM. No desenvolvimento motor fino adaptativo (DMFA), o grupo MPG apresentou desfecho "normal" mais frequente (5; 83,3%), com escore 13,2 pontos na EIS (p < 0,0001). Entre aqueles que evoluíram com "risco" tanto no DMFA quanto no desenvolvimento motor grosseiro (DMG), o grupo de MM se destacou (4; 66,7%), apresentando escore de 12,1 (p < 0,0001). A qualidade da RM mostrou estar associada com o DMFA e DMG de prematuros no primeiro ano de vida, em função do tamanho da prole.

La responsividad materna (RM) es predictor de la adquisición de habilidades motoras de prematuros. El objetivo de este estúdio fue verificar las asociaciones entre la RM y el desarrollo motor (DM) de los bebés prematuros según el tamaño de la descendencia. Participó 18 díades, en tres grupos: madres primíparas y recién nacidos gemelos (MPG), madres primíparas (MP) y madres multíparas (MM). Se utilizaron ficha clínica, Escala de Interacción social (EIS), Protocolo de Observación del DM. En el Desarrollo Motor Fino Adaptativo (DMFA), el grupo MPG presentado el resultado común más frecuente (5; 83,3%), con una puntuación de 13,2 EIS (p < 0,0001). Los que evolucionaron con "riesgo" en los DMFA y desarrollo motor grueso (DMG), las MM se destacaron (4; 66,7%), con puntuación de 12,1 (p < 0,0001). Calidad de la RM asocia con DMFA y DMG de prematuros en el primero año de vida en función del tamaño de la descendencia.

Randomized control trial evaluating the effectiveness of ear plugs in hearing loss in NICU preterm babies

Background: The prevalence of hearing loss is higher in neonates admitted to NICU compared to the general population. Preterm babies are more vulnerable to the hearing damage due to their immature inner ear exposing them to various high frequency noises in the NICU to which they were not accustomed. Most NICU in India exceed the recommended sound levels. In order to reduce damage to the ears, foam-based earplugs are used to reduce the sound intensity reaching the ears of these premature babies.Methods: Babies admitted to NICU are allocated alternatively to receive earplugs or not. Cases are preterm babies with earplugs and controls are the ones without earplugs. The incidence of hearing loss is found by OAE testing of the ears at the end of NICU stay.Results: Out of 40 in each group, 6 babies in control group failed the OAE compared the 3 in the earplug group. Babies who did wear earplugs had longer period of NICU stay.Conclusions: Use of earplugs in babies admitted to NICU reduced the incidence of hearing loss and also length of NICU stay.

A study on vitamin D levels in preterm and term neonates and their mothers

Background: Vitamin D is a fat-soluble vitamin which has immunomodulatory and anti-inflammatory effects. Vitamin D deficiency is a worldwide problem and yet is one of the most under diagnosed and under treated nutritional deficiency. Despite India being in the tropical zone with plentiful sunlight, there is a wide prevalence of vitamin D deficiency.Methods: Cross sectional descriptive study done in a tertiary care hospital involving 30 mother baby dyads equally divided into term and preterm babies. Maternal vitamin D levels (before delivery) and cord blood vitamin D levels (after delivery) were estimated.Results: All the mothers had low vitamin D levels, 93% having deficiency and 7% having insufficiency. The maternal vitamin D levels correlated with cord blood vitamin D levels. There was significant correlation between maternal vitamin D levels and cord blood vitamin D levels with maternal age and parity. There was no correlation between maternal vitamin D levels with gestational age, sociodemographic profile or neonatal anthropometry.Conclusions: Vitamin D deficiency is widely prevalent even in well-nourished mothers. Vitamin D supplementation may be helpful in antenatal mothers. Larger studies are needed to study the prevalence of vitamin D deficiency in mothers and babies and look for effectiveness of supplementation.

Study on therapeutic effectiveness of continuous positive airway pressure compared to mechanical ventilation in preterm babies with respiratory distress

Background: Previously mechanical ventilation was primary modality of treatment in preterm neonates with respiratory distress. With the introduction of continuous positive airway pressure (CPAP), the need of mechanical ventilation is reduced. The present study was done to know the therapeutic effects of CPAP as compared to mechanical ventilation in preterm neonates with respiratory distress. To study the duration of oxygen requirement and duration of hospitalisation in preterm neonates treated with CPAP compared to invasive mechanical ventilationMethods: Hospital based prospective study was conducted from November 2013 to November 2014 in Dr. B. R. Ambedkar medical college, Bangalore. All the preterm babies admitted in neonatal intensive care unit with respiratory distress requiring CPAP or mechanical ventilation during study period were included. Total 50 cases were included, out of which 20 (40%) were on CPAP treatment and 30 (60%) were on mechanical ventilation. Outcome was assessed by reduction of respiratory distress with SpO2 more than 88% with FiO2 of 21%.Results: Out of 50 preterm neonates studied, 20 (40%) were on CPAP treatment and 30 (60%) were on mechanical ventilation. Mean duration of oxygen treatment was less in neonates on CPAP (4.8'0.9 days) compared to mechanical ventilated neonates (7.12'0.8days) and it is statistically significant (p value<0.05). Mean duration of hospitalisation was less in neonates on CPAP (19.3'0.76 days) compared to mechanical ventilated neonates (21'1.2 days) but it was statistically not significant (P value >0.05).Conclusions: CPAP as a mode of treatment for preterm babies with respiratory distress reduces the duration of oxygen dependency compared to invasive mechanical ventilation. Difference in duration of hospital stay was statistically not significant in these neonates treated with CPAP and mechanical ventilation.

Safety of aggressive nutrition bundle-aggressive parenteral nutrition, standardized feeding policy, human milk fortification and probiotics in babies born less than 34 weeks of gestation: a prospective analytical cohort study

Background: Despite changes in nutritional interventions in neonatal intensive care units worldwide, significant proportion of preterm babies are growth restricted at discharge. Authors intended to look at the feasibility of aggressive nutrition bundle (aggressive parenteral nutrition, standardized feeding policy, fortification and probiotics) in preterm neonates.Methods: This single centre prospective analytical cohort study, involving babies born before 34 weeks of gestation, was conducted in a tertiary hospital. Aggressive parenteral nutrition and enteral nutrition bundle intervention was started within 24 hours of birth. Clinical, laboratory and anthropometrical parameters were monitored longitudinally to ensure safety of this intervention.Results: Mean gestational age and birth weight of the cohort (n=107) was 30.6 weeks (SD'2.6) and 1147 grams (SD'287) respectively. Out of 107 babies, 67.3% (n=72) have extra uterine growth retardation (EUGR) at discharge and was more in small for gestational age neonates (p=0.001). With this aggressive parenteral and enteral nutrition bundle intervention, medical necrotizing enterocolitis (NEC) developed in 7.4 % (n=8) babies while surgical NEC was seen in 1.9%. (n=2). Early onset and late-onset sepsis occurred in 1.8% and 5.4% of babies respectively while mild hyperammonemia, mild hypertriglyceridemia, raised creatinine and urea developed in 12.4%, 4.6%, 7.4% and 11.7% respectively. Hyperglycemia and hypoglycemia were present in 8.8% and 5.6% babies respectively.Conclusions: Aggressive nutrition bundle (aggressive parenteral nutrition, standardized feeding policy, fortification and probiotics) can be safely employed in preterm babies. There is an urgent need to design a study to see the impact of this approach on incidence of EUGR in preterm babies.

Mortality and morbidity of very low birth weight and extremely low birth weight babies in neonatal period

Background: Preterm birth is one of the major clinical problems in neonatology as it is commonly associated with perinatal mortality, serious neonatal morbidity and in some cases, it leads to childhood disability. The objective of this study was to find out the outcomes of VLBW and ELBW babies in the form of mortality and morbidity in neonatal period.Methods: A cross sectional study was conducted in SNCU, MKCG Medical College, Berhampur, Odisha between 2011 to 2013. All babies with birth weight less than 1500gm, admitted between days 1 to day 7 of life were enrolled in the study. Babies were broadly divided in to two groups i.e.VLBW group (weight 1000-1499gm) and ELBW group (weight<1000gm). Details of antenatal history, sociodemographic profile and birth history including significant events were noted. Outcome measures included were death, cured and with sequelae.Results: Total number of babies enrolled in this study were two hundred twelve (n=212) and following observations were made. Mortality of ELBW babies was 61.11% and that of VLBW babies was 26.41%. Death rate in babies with weight range 500-749gm, 750-999gm, 1000-1249gm and 125-1499gm was 87.50%, 53.57%, 30.76% and 20.97% respectively. It was found that morbidities such as RDS, HIE, shock and hypoglycemia are significantly higher in ELBW babies as compared to VLBW babies.Conclusions: Extremely low birth weight babies have shown high mortality and morbidity compared to very low birth weight babies and its related death multiply when associated with complications like hyaline membrane disease, hypoxic ischemic encephalopathy, and sepsis.

Comparative study of hemoglobin and packed volume levels in term and preterm babies delivered in RMMCH

Background: Most existing accounts of hemoglobin values in healthy premature infants covering the early weeks of life were written before many of the errors of such determinations were recognized. Because of these limitations, it was decided to review the normal values for the first three months of life. The results were compared with a small series of readings made on a group of healthy, full-term infants. Aim: To compare hemoglobin and packed volume levels in term and preterm babies. Materials and methods: Sixty pregnant women who came from in and around Chidambaram who fulfilled the inclusion criteria during the period from July 2001 to March 2002 were included in this study. Among them, 50 delivered at term (37 to 42 weeks) and the rest delivered prematurely (< 37 weeks). Hemoglobin and packed cell volume as measured by standardized technique. The results were analyzed accordingly. Results: The estimated mean hemoglobin concentration of the term babies was 10.88 gm% with the standard deviation of 1.5 gm%. For preterm babies, the mean hemoglobin concentration was 10.33 gm% with the standard deviation of 2 gm%. The mean calculated packed cell volume (PCV) of the term babies was 34.03% and the standard deviation was found to be 5%. The mean packed cell R. Manimozhi Malathi, S. Ramesh, R. Aravind Kumar. Comparative study of hemoglobin and packed volume levels in term and preterm babies delivered in RMMCH. IAIM, 2018; 5(9): 54-57. Page 55 volume of the premature babies in the present study was found to be 32.75% with the standard deviation of 6.5%. Conclusion: Anemia of prematurity is a multifactorial anemia characterized by low levels of erythropoietin (EPO), iatrogenic blood loss, low circulating blood volume and lack of erythropoiesis. It is a problem due to the high incidence, associated symptoms and increased transfusion requirements. It is a normochromic normocytic anemia hypo-regenerative that occurs between the 2nd and 6th weeks of age in premature infants with gestational age (GA) up to 35 weeks.

Adherencia a las inmunizaciones en niños nacidos con menos de 1.500 gr de peso o antes de 32 semanas de gestación, en dos centros chilenos / Adherence to immunizations in newborns less than 1500 gr at birth and/or younger than 32 weeks, in two chilean centers

Preterm neonates less than 1500 gr. or younger than 32 weeks have an increased morbidity and mortality due to infectious diseases. Immunization of these children is critical but is often incomplete and delayed. Objectives: To describe the adherence of scheduled and additional vaccines recommended in preterms less than 1500 gr. and to compare the level of compliance in two centers. Patients and Methods: Prematures less than 1500 gr. born between January 2006 and December 2008 in a private center (HCPUC) and in a public health system (HSR) were included. Neonatal charts and follow up records were reviewed. Demographic data, diagnosis, scheduled vaccines, delays and its causes, prescription of additional vaccines were registered. Results: 92 children were included in HCPUC and 246 in HSR. Among these 60-70 percent respectively had delayed immunizations. The reasons for these were considered not justified in almost 80 percent of the cases, being the primary reason oversight or lack of parental time. The use of additional vaccines is still low in both centers. Conclusions: Vaccination of prematures in Chile requires important improvements; education of healtheare personnel and parents, inclusión of modern computerized records and inclusión of new efficacious and safe vaccines in the regular immunization program with no cost to the patient.

Los niños prematuros menores de 1.500 gr o de 32 semanas de gestación al nacer (RNMBPN) tienen mayor morbimortalidad por enfermedades infecciosas. La vacunación de estos niños es una medida esencial, la que, sin embargo, es subóptima. Objetivo. Describir la adherencia a las vacunas programáticas (PNI) y adicionales recomendadas en RNMBPN en dos centros y comparar su nivel de cumplimiento. Pacientes y Métodos. Se incluyeron RNMBPN nacidos entre enero 2006 y diciembre 2008 de un centro privado (HCPUC) y otro del sistema público (HSR). Se registraron a partir de fichas neonatales y de consultorio de seguimiento, datos demográficos, diagnósticos, vacunas PNI, retrasos y causas de éstos y prescripción de vacunas adicionales. Resultados. Se describen 92 niños en el HCPUC y 246 en el HSR, 60 y 70 por ciento respectivamente tienen alguna vacuna atrasada. En ambos centros las razones fueron no justificadas en 80 por ciento de los casos, siendo la razón principal olvido o falta de tiempo de los padres. El uso de vacunas adicionales es aún escaso en ambos centros. Conclusiones. La vacunación del prematuro en nuestro país requiere mejorías que incluyan educación del personal de salud y padres, mejoras en los registros e incorporación al programa de nuevas vacunas eficaces y seguras sin costo para los pacientes.

Comparison between immunological markers in cord blood of preterm and term babies in Hospital USM

A cross sectional pilot study using convenient sampling method was conducted to evaluate various immunological parameters in preterm babies and term babies. Cord blood from 36 preterm and 36 term babies was taken and the following parameters were determined: Immunoglobulin G, A and M, Complement 3 and 4 and NBT. The results showed that NBT was significantly reduced in preterm babies compared to term babies (7.5% versus 12.0%; p= 0.001). The complement levels, C3 (0.5114 versus 0.7192 g/l; p<0.001) and C4 (0.07 versus 0.14g/l; p<0.001) were significantly lower in preterm babies than in the term babies. The mean IgG level in preterm babies was significantly lower than in term babies (9.5583 versus 14.2806 g/l, p<0.001). IgM (0.1 versus 0.2g/l; p<0.001) and IgA (0.210 versus 0.225g/l; p=0.036l) levels were significantly lower in the preterm than in term babies. In conclusion, we found that NBT reduction, IgG, IgA, IgM, C3 and C4 levels were significantly lower in the preterm compared to term babies.