Association between admission temperature and mortality and major morbidity in very low birth weight neonates - single center prospective observational study.

BACKGROUND AND OBJECTIVE: Hypothermia is a common problem especially in preterm neonates and has been associated with increased neonatal mortality and morbidities. The objective of our study was to look into the distribution of admission temperature among VLBW neonates getting admitted to the NICU, association of admission temperatures to selected neonatal morbidities/mortality, and to evaluate for modifiable factors contributing to hypothermia. METHODS: Infants with birth weight between 500 and 1499 g and gestation ≥ 25 weeks without major congenital malformations delivered between October 2017 and March 2020 who were admitted directly from the delivery room to the NICU were included in the study. Data were collected prospectively on perinatal/birth characteristics to look for their association with admission hypothermia, and to look into the association of admission temperature with selected neonatal morbidities/mortality. RESULTS: There were a total of 538 neonates with the mean birth weight of 1206 ± 271 g included in the study. Mean admission temperature was 35.8 ± 1.3 °C. Low delivery room temperature was the most important contributor to admission hypothermia. Also, 3.3% of neonates were hyperthermic at admission to NICU, all of them having been delivered to mothers with intrapartum pyrexia. On adjusted analysis, we found that low admission temperature significantly increased therisk of adverse composite neonatal outcomes with admission temperature < 34.5 °C having 42% increased risk of the adverse outcome when compared to normothermic neonates. CONCLUSION: Admission hypothermia remains a common problem in preterm neonates which is significantly associated with adverse neonatal outcome.

Enablers and barriers for enteral feeding with mother`s own milk in preterm very low birth weight infants in a tertiary care neonatal intensive care unit.

BACKGROUND: The management of lactation in preterm mothers is a real challenge for Neonatal Intensive Care Unit (NICU) care, providers. The study aimed to evaluate the enablers and barriers for enteral feeding with mothers` own milk (MOM) in preterm very low birth weight (VLBW) infants in a tertiary care neonatal unit. METHODS: This prospective observational study took place at a tertiary level NICU of a high-risk obstetric unit in a private hospital. All VLBW infants and mothers were incorporated into the study. Data on enablers and barriers were gathered from mother-baby dyads at the time of birth, at the end of the 7th day, and then weekly till the discharge of the baby from the unit. RESULTS: We studied 87 mother-baby dyads. Mean (SD) maternal age, gestation age and birth weight were 29.3 (4.7) years, 30.8 (2.0) weeks, and 1196 (196) grams respectively. We categorized our data into 2 groups based on outcome estimates done during the entire hospital stay or pre-discharge (48 hours before the discharge). On comparison of perinatal and post-natal factors, the enablers were maternal dwelling from the rural locality, number of milk expression son day 1 after the birth, number of night expressions in the first week postnatally, and MOM volume till day 3, day 7, and 2 weeks postnatally. The enablers of MOM in the pre-discharge group were the number of expressions in the first 3 days, the number of night expressions in week 1, mother`s visit, and the number of maternal visits on day 1 to NICU and MOM volume expressed from day 1 until the second week after birth. The main barriers for MOM (48 hours pre-discharge) were extremely low birth weight (ELBW) and intrauterine growth-restricted infants (IUGR). CONCLUSIONS: ELBW infants and IUGR infants are susceptible to low MOM feeding. The total of milk expressions in the first 3 days, number of night expressions in the first week, maternal visits on day 1 and the average MOM amount in the first 2 weeks are enablers for MOM feeding.

Comparison of Fenton 2013 growth curves and Intergrowth-21 growth standards to assess the incidence of intrauterine growth restriction and extrauterine growth restriction in preterm neonates ≤32 weeks.

BACKGROUND: Close monitoring of growth pattern in preterm neonates is essential to identify any deviations from the normal pattern. But, there is no international consensus regarding how the growth of preterm neonates should be monitored or what constitutes the ideal pattern of growth in these premature infants. OBJECTIVE: To compare the incidence of IUGR & EUGR in preterm neonates ≤32 weeks gestational age based on Fenton 2013 growth curves and Intergrowth-21 growth standards. DESIGN: Retrospective Cohort Study. STUDY SITE: Tertiary care neonatal unit with nearly 1000 admissions to the neonatal unit. PARTICIPANTS: All newborns with gestational age ≤32 weeks (230 6/7 days) admitted to the NICU within 24 h of birth over a period of 3 years from 1 January 2015 to 31 December 2017. RESULTS: Out of 821 neonates born during the study period 603 were included. The mean birth weight, length, and head circumference were 1356.683 ± 335.91 g, 39.244 ± 3.124 cm, and 27.819 ± 1.906 cm, respectively. The mean discharge weight, length, and head circumference were 1550.70 ± 185.122 g, 41.606 ± 2.026 cm, and 29.398 ± 1.221 cm, respectively. The proportion of infants identified as IUGR at birth with respect to weight, length, and head circumference on both the charts was 15.1, 14.4, and 9%, respectively. The proportion of infants identified as EUGR at discharge with respect to weight, length, and head circumference on both the charts was 45.7, 29.8, and 32.3%, respectively. CONCLUSION: The proportion of infants identified as IUGR at birth and EUGR at discharge differed on the usage of Intergrowth charts (Birth reference and postnatal) in comparison to Fenton growth charts. The infants identified as IUGR at birth by Intergrowth charts and not by Fenton growth charts had higher incidence of morbidities.

Plethysmography variability index (PVI) changes in preterm neonates with shock-an observational study.

Shock is an acute state of circulatory dysfunction. The diagnosis of shock is complex in neonates. The relative sensitivity of current clinical or laboratory findings for detecting shock is largely unknown, especially for preterm neonates. For preload assessment, inferior vena cava (IVC) collapsibility can be a useful bedside echocardiography parameter. plethysmography variability index (PVI) is a marker of fluid responsive shock in adults and children, but not well defined in neonates. In this prospective observational study, we evaluated the changes in PVI in preterm neonates with shock. Among the 37 infants enrolled in the study, the mean blood pressure (MAP) was 45 (± 4 mm of Hg) and none of infants had hypotension. The mean pulse pressure was 28 mm of Hg, the mean PVI was 28% (±5), the mean arterial blood gas pH was 7.20 (±0.07), and the mean base deficit was 9.9 (±2.53) at the onset of shock. Thirty (96.77%) of the 31 infants with resolution of shock showed decrease in PVI with an average decrease of 11% (±5).Conclusion: Significant proportion of neonates show an increase in PVI at the onset of shock. What is Known: • Plethysmography Variability Index (PVI) is commonly used as a marker of volume status in paediatric population. • Changes in PVI may guide in giving volume boluses in patients with shock. What is New: • This study provides information of changes in PVI in preterm neonates with shock. • PVI may become a valuable tool to be used at bedside in preterm infants with shock.

Growth and Neurodevelopmental Outcomes at 12 to 18 Months of Corrected Age in Preterm Infants Born Small for Gestational Age.

OBJECTIVE: To compare the growth and neurodevelopmental outcomes at 12 to 18 months of corrected age in preterm infants (gestation < 35 wks) born appropriate for gestation (AGA) with those born small for gestation (SGA). METHODOLOGY: This cross sectional, study assessed the growth outcomes in terms of underweight, stunting, microcephaly, overweight and obesity. Development delay was defined as developmental quotient < 70 on DASII. RESULTS: Out of 178 infants enrolled in the study 119 were AGA and 59 were SGA. The mean gestational age of the study cohort was 30.45 (2.08) weeks. More infants in the SGA group were underweight (59.3% vs. 37.8%, RR: 1.79, 95% CI: 1.16-2.74), stunted (62.7% vs. 30.25%, RR: 2.19, 95% CI: 1.42-3.36) and had higher incidence of motor (6.7% vs.0.8%, RR: 2.5, 95% CI: 1.5-4.1) and mental development (3% vs. 0, RR: 3.1, 95% CI: 2.5-3.8) delay. CONCLUSIONS: Preterm SGA infants are at an increased risk of underweight, stunting, motor and mental development delay when compared with preterm AGA infants in early childhood.

Effect of colostrum given within the 12 hours after birth on feeding outcome, morbidity and mortality in very low birth weight infants: a prospective cohort study.

The current study aims to compare the feeding outcome, morbidity and mortality in very low birth weight (VLBW) infants who received early colostrum (<12 hours of life) and those who did not. All VLBW infants admitted to neonatal intensive care unit (NICU) were eligible for the study. Eligible infants were enrolled after obtaining written informed consent from either of the parents. Newborns who received colostrum within the first 12 hours after birth formed the study cohort and all others the control cohort. Both cohorts were followed till discharge from NICU. During the study period, 205 VLBW infants were admitted in NICU of whom 171 (83%) infants were enrolled in the study. Both study groups were comparable for mean birth weight, mean gestation and male sex. The proportion of infants with abnormal Doppler was significantly higher in the control group. All outcomes were adjusted for antenatal Doppler abnormalities. The primary outcome of time to reach full feeds in the study population was 6.90 ± 4.4 days as compared to 9.80 ± 4.86 days in the control group with a significant weighted mean difference of -2.4 (-0.8 to -3.9) days. Duration of total parenteral nutrition (TPN) days and mortality were all lower in the study cohort. Risk of sepsis and necrotising enterocolitis was similar in the both groups. Enteral colostrum within first 12 hours of birth in VLBW infants reduces the time to reach full feeds, TPN days and mortality.

'Nasal mask' in comparison with 'nasal prongs' or 'rotation of nasal mask with nasal prongs' reduce the incidence of nasal injury in preterm neonates supported on nasal continuous positive airway pressure (nCPAP): A randomized controlled trial.

BACKGROUND: With increasing use of nCPAP, the safety and comfort associated with nCPAP have come into the forefront. The reported incidence of nasal injuries associated with the use of nCPAP is 20% to 60%. A recent meta-analysis concluded that the use of nasal masks significantly decreases CPAP failure and the incidence of moderate to severe nasal injury and stress the need for a well powered RCT to confirm their findings. METHODS: In this Open label, 3 arms, sequential, stratified randomized controlled trial, we evaluated the incidence and severity of nasal injury at removal of nCPAP when using two different nasal interfaces and in three groups (i.e. rotation group, mask continue group, prong continue group). Preterm infants with gestation ≤ 30 weeks and respiratory distress within the first 6 hours of birth and in need of CPAP were eligible for the study. RESULTS: Among the 175 newborns included in the study, incidence of nasal injury in mask continue group [n = 19/57 (33.3%)] was significantly less as compared to prong continue group [n = 55/60 (91.6%)] and rotation group [33/ 58 (56.9%), p value <0.0001]. Median maximum nasal injury score was significantly less in Mask continue group as compared to Prong continue group and Rotation group [Injury Score 0 (IQR 0-1) vs. Injury Score 3 (IQR 2-5) vs. Injury Score 1 (IQR 0-2), p value = <0.0001] respectively. The proportion of infants failing nCPAP was similar across the three groups. CONCLUSION: nCPAP with nasal masks significantly reduces nasal injury in comparison with nasal prongs or rotation of nasal prongs and nasal masks. However, the type of interface did not affect the nCPAP failure rates.