A Randomized Controlled Trial Comparing the Duration of Phototherapy Following NICE and AAP Guidelines in Neonatal Hyperbilirubinemia

Aims and Objectives: To compare duration of phototherapy between AAP and NICE guidelines in neonatal hyperbilirubinemia. Methods: In an open labelled study 130 babies with non-haemolytic hyperbilirubinemia were randomised to receive phototherapy following one guidelines between AAP and NICE. In this study we compared AAP 2004 and NICE 2010 guidelines to see whether following any of these two guidelines leads to phototherapy for longer duration. The primary outcome variable was duration of phototherapy and the secondary outcome variable was failure of phototherapy, defined as inability to reduce the TSB level of 2-3 mg/dl from baseline within 6 hours of phototherapy or inability to reduce TSB below exchange level. Results: Median age at onset of phototherapy was 77.55(19.43)hours in AAP group and 73.57(12.93) hours in NICE group, median gestational age was 37weeks in AAP group and 38weeks in NICE group, mean birth weight 2377.92gm in AAP group and 2457.10 gm. in NICE group, mean serum bilirubin at the onset of phototherapy was 18.77(1.570) mg/dl in AAP group and 18.24(1.89)g/dl in the NICE group. Average spectral irradiance was 55.8(µw/cm2/nm) in the study. Median duration of phototherapy in NICE as well as AAP group was 18 hours. There was no treatment failure in either group. Neurological examination was done at 40 weeks and 3 moths of corrected age. No abnormal neurological examination or BERA finding was reported in any of the babies. Conclusion: There is no difference in duration of phototherapy in any of the guidelines.

Acceptability of Latch Breastfeeding Assessment Tool as a Predictor of Breastfeeding Duration

Background: This study aims to test the validity of LATCH tool to check if it can predict breastfeeding duration at 6 weeks postpartum. Methods: Mother-infant dyads were evaluated using LATCH breastfeeding assessment tool within 36 to 72 hours postpartum. Participants are healthy newborns at term gestation, birth weight ≥2500gm, born by vaginal delivery or C-section, rooming with their mothers. After 6 weeks postpartum, participants were followed up and were asked their experience of breastfeeding. Results: Total 130 mother-infant dyads participated; among which 122 attended follow up at 6 weeks. 108 infants were on breastfeeding and 14 mothers had reported they had stopped breastfeeding. LATCH score of the mother-infant dyads who continued breastfeeding for 6 weeks postpartum was 8.4±1.2 and those who stopped breastfeeding had LATCH score 8.5±0.9. ROC curve does not show any acceptable cut off to predict breastfeeding at 6 weeks. Conclusion: Early breastfeeding assessment using LATCH tool within 36 to 72 hours postpartum could not predict breastfeeding duration. Further studies with large sample size are warranted.

Can Shaker Water Bath be used as Low Cost Pasteurization Device in Human Milk Banks?

Background: Pasteurization is the most crucial step for donor milk processing in human milk banks and Holder pasteurization is the most widely accepted method. Automated instruments are available for pasteurization but they are costly. Shaker water bath is also used for pasteurization which is a cheaper device. In this study we checked the quality of pasteurization carried out in shaker water bath.Objective: Evaluation of biological safety of pasteurized human Milk by Shaker water bath and to see if pasteurization using shaker water bath alters macro-nutrient values of milk using human milk analyzer. Methods: (a) Bacteriologic quality of post pasteurized milk of 80 pasteurization cycles by shaker water bath. (b) Macro-nutrient values of pre and post pasteurized milk samples from shaker water bath are measured from 20 different cycles using Human Milk Analyzer (MIRIS AB, Sweden). These 20 samples were selected using computer generated random table. Results: Bacteriologic testof pre pasteurized sampleswere comparable and colony count of all samples were within acceptable limit (Gram negative bacilli <104, Gram positive cocci <104). None of the post pasteurized samples showed any growth. Shaker water bath pasteurization did not alter macro nutrient values (protein: 1.56±0.23g/dl, fat: 3.20±0.35g/dl, energy: 64.00±3.08Kcal/dl). Conclusion: Shaker water bath is a low cost pasteurization device for Holder pasteurization of human milk; there is no alteration of milk quality and is bacteriologically safe as well

The Early use of CPAP in Neonatal Pneumonia: Randomized Control Trial

Background: Aim- To assess clinical resolution of neonatal pneumonia by early use of CPAP. Study design- Randomized control trial.Methods: Neonates with a gestational age of >35 weeks having tachypnea (RR≥ 60/min) and respiratory distress were included in the study. The neonates were subjected to a radiological examination for confirmation of pneumonia. Further a sepsis screen was performed, if the screen was positive, the patient was enrolled for inclusion in the study. The randomization allocation was done and the babies allotted to the study (CPAP) group or the control group. Babies in study group were put on CPAP soon after randomization allocation and the babies in the control group were managed as per the unit protocol. Results: It has shown that the early use of CPAP in addition to standard treatment results in early resolution of clinical pneumonia & significant reduce the duration of oxygen therapy. Further it lowered the need for mechanical ventilation. However there was no difference in the duration of hospital stay in the two groups. CPAP was well tolerated by the neonates (both late preterm and term) with few complications. No baby’s condition gave concern that there could be a significant air leak. Conclusion: In our study, the early use of CPAP in addition to standard treatment results in early resolution of clinical pneumonia & significant reduce the duration of oxygen therapy. Further it lowered the need for mechanical ventilation. CPAP was well tolerated by the newborn (both late preterm and term) with few complications.