Utility of Bain’s Circuit to Deliver Respiratory Support in a Resource‑Limited Setting during the COVID‑19 Pandemic

Introduction:Patients with COVID pneumonia, who did not respond to high‑flow oxygen by nonrebreathing mask (NRBM), needed additional support to deliver oxygen with pressure. We present our innovation to use Bain’s circuit to deliver continuous positive airway pressure (CPAP) along with 100% oxygen in patients with COVID‑19 when there was a shortage of respiratory support equipment. Materials and Methods: It is a retrospective observational study conducted at two high‑volume, government‑designated, tertiary level COVID centers of Northern India, during May and June 2021. After taking informed consent from all patients included in the study, a nonventilated noninvasive ventilation (NIV) mask was used as the interface between Bain’s circuit and the patient for making a tight seal. Vital parameters were recorded on admission, before putting the patient on Bain’s circuit, at 30 min, and 6 h after the initiation of Bain’s circuit. Results: Forty‑five patients were enrolled in this study. There was a significant reduction in the work of breathing after the application of Bain’s circuit. Vital parameters show improvement of the condition. Sensorium also showed a significant improvement after the application of Bain’s circuit. Overall, 40% of patients who received Bain’s circuit were weaned off to oxygen by NRBM, 31.1% of patients were bridged to NIV, and 28.9% of patients got intubated. Conclusion: The aim of presenting our experience is to generate interest regarding innovations in the face of crisis which may not be perfect but are practical for the situation. We do not recommend the use of Bain’s circuit to provide NIV support under normal circumstances. Further studies are needed to support the use of Bain’s circuit with modifications as a CPAP/NIV delivering device in selected patients.

Prevalence of exclusive breastfeeding and knowledge related to breastfeeding among mothers attending immunization center and well-baby clinic

Background: The World Health Organization defines exclusive breastfeeding (EBF) as giving baby only breast milk for the first 6 months without adding any additional drink including water or food. We undertook this study with an objective to assess the prevalence of breastfeeding among mothers in North Indian setting. Aims: The aims of this study were to assess the prevalence of EBF among mothers attending a well-baby clinic and to look for variable significantly impacting probability of breastfeeding and assessing the challenges faced and existing knowledge regarding breastfeeding. Materials and Methods: This was a questionnaire-based one-point survey to assess the prevalence of EBF. The questionnaire was based on the review of literature and included parameters considered significant by various studies. Mother's knowledge regarding breastfeeding was assessed by another questionnaire. Results: A total of 970 mothers were approached who visited immunization center and well-baby clinic during the study. After taking out those who were unwilling and did not meet the criteria, we had 634 mothers who participated in our study. They were divided into two groups based on whether they exclusive breastfed their babies for 6 months or not. Comparison of both these groups revealed breastfeeding counseling to be the most important variable. Statistical Analysis Used: It is a cross-sectional type of study with a questionnaire-based one-point survey. The minimum sample size required was calculated using Daniel's formula: n = z2pq/d. Consequent sampling was done. Chi-square test for independence was done to assess the association between both the groups for all the parameters recorded. Conclusions: All mothers were aware that breast milk is beneficial for their baby; however, the biggest problem was anxiety regarding the adequacy of their breast milk. There is also need for a widespread campaign related to harm done by prelacteals and substitutes of breast milk including cow milk.

Outcome Prediction Value of Red Cell Distribution Width in Critically- ill Childre

Objective: To study the association between red cell distribution width (RDW) and mortalityin critically-ill children admitted in a Pediatric intensive care unit (PICU). Methods: 101participants were recruited consecutively over 3 months. Data collected includeddemographics, vital parameters, laboratory values, severity and organ failure scores, RDWfor the first 5 days of admission, duration of PICU stay and survival outcome. Results: 11patients died during study period. High RDW at admission (RDW D1) correlated significantlywith mortality (P=0.007). The odds of death increased by 15 to 23 times with rise in RDW D1from 18% to >21%. The optimal RDW D1 cut-off value for mortality was 18.6%, which yieldedsensitivity 90.9%, specificity 70.8%, positive predictive value 27.8%, negative predictivevalue 98.4%, and area under curve (AUC) 0.83 (95%CI 0.737, 0.925). 29 out of 60 (48.3%)patients with RDW D4 >18% had PICU stay of ?7 days. Conclusion: High (?18.6%) RDW atadmission and its persistent high levels are associated with high mortality and prolonged stayin PICU, respectively