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Background: In preterm neonates, enteral feeding is advancedslowly, considering the risk of necrotizing enterocolitis. Prolongedintravenous alimentation in these neonates, however, mayincrease the risk of sepsis-related morbidity and mortality,particularly in low resource settings.Objectives: Objective of this was study to evaluate impact ofaggressive enteral feeding on mortality and morbidities amongpreterm neonates.Design: Randomized controlled trial.Participants: Neonates with birthweight 750-1250 g.Interventions: 131preterm neonates with birth weight 750-1250g, admitted to neonatal intensive care unit between April 2012 andJune 2014, were randomized to aggressive feeding orconservative feeding regimen.Outcomes: The primary outcome of the study was all-causemortality during hospital stay. The secondary outcomes includedproportion of sepsis (blood culture proven), necrotizingenterocolitis, feed intolerance, survival without major morbidity atdischarge, time to reach full enteral feed (180 mL/kg/d), durationof hospitalization, and average daily weight gain (g/kg).Results: All-cause mortality was 33.3% in aggressive regimenand 43.1% in conservative regimen, [RR (95%) CI 0.77 (0.49,1.20)]. Neonates with aggressive feeding regimen reached fullenteral feed earlier; median (IQR) 7 (6, 8) days compared toconservative regimen, 10 (9, 14) days; P <0.001. There was nodifference in culture positive sepsis rate, survival without majormorbidities, feed intolerance, necrotizing enterocolitis, duration ofhospitalization and average daily weight gain.Conclusions: In neonates with birth weight 750-1250 g, earlyaggressive feeding regimen is feasible but not associated withsignificant reduction in all-cause mortality, culture positive sepsisor survival without major morbidities during hospital stay.Neonates with aggressive regimen have fewer days on IV fluidsand reach full feed earlier
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Background & objectives: Banaba (Lagerstroemia speciosa L.) extracts have been used as traditional medicines and are effective in controlling diabetes and obesity. The aim of this study was to evaluate the anti-HIV property of the extracts prepared from the leaves and stems of banaba, and further purification and characterization of the active components. Methods: Aqueous and 50 per cent ethanolic extracts were prepared from leaves and stems of banaba and were evaluated for cytotoxicity and anti-HIV activity using in vitro reporter gene based assays. Further, three compounds were isolated from the 50 per cent ethanolic extract of banaba leaves using silica gel column chromatography and characterization done by HPLC, NMR and MS analysis. To delineate the mode of action of the active compounds, reverse transcriptase assay and protease assay were performed using commercially available kits. Results: All the extracts showed a dose dependent inhibition of HIV-1-infection in TZM-bl and CEM-GFP cell lines with a maximum from the 50 per cent ethanolic extract from leaves (IC50 = 1 to 25 μg/ml). This observation was confirmed by the virus load (p24) estimation in infected CEM-GFP cells when treated with the extracts. Gallic acid showed an inhibition in reverse transcriptase whereas ellagic acid inhibited the HIV-1 protease activity. Interpretation & conclusions: The present study shows a novel anti-HIV activity of banaba. The active components responsible for anti-HIV activity were gallic acid and ellagic acid, through inhibition of reverse transcriptase and HIV protease, respectively and hence could be regarded as promising candidates for the development of topical anti-HIV-1 agents.
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India has made impressive gains in its child survival indices during the past half a century with infant mortality rates declining from 159.3 in 1960 to 44 in 2011 and neonatal mortality rate declining from 47 (1990) to 32 (2010). Neonatal health is now an integral part of the country’s flagship program – National Rural Health Mission. Facility based newborn care is not only available in large public and private sectors hospitals, but also in about 300 of India’s district hospitals. Complementing these efforts is home based newborn care being delivered by community health volunteers. The last two decades has also witnessed an increase in newborn research and its incorporation into medical and paramedical education as a major course component. Neonatology now is an independent superspecialty in India. The National Neonatology Forum has had a major role in spearheading reforms in neonatal care in India.
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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.