Screening and Management of Congenital Hypothyroidism - Guidelines by American Academy of Pediatrics, 2023.

Guidelines for screening and management of congenital hypothyroidism in neonates have been recently updated by the American Academy of Pediatrics (AAP). This article compares new AAP guideline with the Indian Society for Pediatric and Adolescent Endocrinology (ISPAE) Guidelines, 2018 and lists the changes in screening, diagnosis, and management of congenital hypothyroidism suggested in the new guidelines, along with clinical utilization in the Indian scenario.

Comparison between Phenobarbitone and Levetiracetam as the initial anticonvulsant in preterm neonatal seizures - a pilot randomized control trial in developing country setup.

This study aimed to compare the efficacy and safety of intravenous Levetiracetam and Phenobarbitone in the treatment of seizures in preterm neonates. It was an open-labeled, parallel randomized controlled trial conducted in a tertiary Neonatal Intensive Care Unit, India. Total 48 preterm neonates (28-36+6 weeks) with clinical seizures were randomized to receive either Levetiracetam (LEV; 40 mg/kg, then 20 mg/kg) or Phenobarbitone (PB; 15 mg/kg, then 10 mg/kg) intravenously as first loading dose in ratio 1:1; second loading was given for persistent seizure. Efficacy was denoted by cessation of clinical seizures with first or second doses of the allotted antiepileptic, and remaining seizure-free for the next 24 h. The demographic characteristics of preterm neonates and seizure types were comparable between both groups. Clinical seizure was controlled in 19 (79%) neonates in LEV group and 17 (70%) neonates in PB group, RR 1.12 (95% CI: 0.80 to 1.55), p = 0.504. There was increased respiratory support in PB group 9 (38%) vs. 3 (13%) in LEV group, RR 3.0 (95% CI: 0.92 to 9.74), p = 0.06.  Conclusion: Levetiracetam and Phenobarbitone were equally efficacious for clinical neonatal seizure control, but increased respiratory support was found with Phenobarbitone use. What is Known: • Preterm neonates are at higher risk of neonatal seizure and Phenobarbitone is commonly used as the first line antiepileptic drugs in treating them. What is New: • Levetiracetam found equally efficacious as Phenobarbitone for cessation of clinical seizures in preterm neonates, with less adverse effect.

Accuracy to detect neonatal hyperglycaemia using real-time continuous glucose monitoring during postoperative period.

Identifying hyperglycaemia during postoperative period is essential for neonates. The objective of the study was to analyse the accuracy and reliability of continuous glucose monitoring (CGM) device for detecting hyperglycaemia during postoperative period in neonates. In this prospective study, hourly glucose recordings by CGM device and six hourly by glucometer glucose (GG-reference test for patient management) were collected in ten surgical neonates during first three postoperative days. Mean absolute relative difference (MARD) and proportion of CGM values within ± 15%/15 mg/dL, ± 20%/20 mg/dL, and ± 30%/30 mg/dL of GG, were analysed from matched pair CGM and GG recordings. The diagnostic performance of CGM for neonatal hyperglycaemia (> 150 mg/dL) was expressed as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV); and the clinical reliability was assessed in Clarke Error Grid Analysis. A total of 720 CGM glucose readings, 120 matched -paired glucose readings by CGM --GG, and 37 episodes were hyperglycaemia by GG. The MARD was 10.76 %; the percentages of glucose readings within 15%/15 mg/dL, 20%/20 mg/dL, and 30%/30 mg/dL were 94.6%, 97.3% and 100% during the hyperglycaemia period. The sensitivity, specificity, PPV and NPV to detect hyperglycaaemia by CGM device were 100%, 93.9%, 88% and 100 % respectively. In Clarke Error Grid Analysis, 97.3 % points were in zone A and B during the hyperglycaemia period. CONCLUSION: CGM device can be a clinically reliable tool for hyperglycaemia management during postoperative period in neonates. WHAT IS KNOWN: • Neonates are vulnerable for hyperglycaemia during post-operative period and bed side glucometers are used for frequent glucose monitoring in them. • Continuous glucose monitor(CGM) devices are used for the glucose monitoring in adult and paediatric diabetes care. WHAT IS NEW: • For the first time, this study analysed the accuracy and clinical reliability of FreeStyle Libre (CGM device) for identifying hyperglycaemia during post-operative period in neonates. • CGM device has very good accuracy for detecting hyperglycaemia in neonates, it may help the clinician for better glucose stability during post-operative period.

Comparison between oral melatonin and 24% sucrose for pain management during retinopathy of prematurity screening: a randomized controlled trial.

BACKGROUND: Preterm neonates perceive multiple painful procedures during Neonatal Intensive Care Unit (NICU) stay, having long term neurobehavioral effects. This study aims to compare the analgesic efficacy of oral melatonin with 24% sucrose in neonates during retinopathy of prematurity (ROP) screening. METHODS: A prospective, non-blinded, randomized controlled trial was conducted in a tertiary care NICU. All preterm neonates with gestational age (GA) < 34 weeks or birth weight (BW) < 2000 grams eligible for ROP screening were randomized into oral melatonin (4 mg/kg) and oral 24% sucrose (0.5 ml) groups. Both groups received standard non-pharmacological measures and topical proparacaine. The intensity of pain was measured by Premature Infant Pain Profile (PIPP) score during the procedure, at 1st and 5th minutes following the procedure and compared between the two groups by Mann-Whitney U test with p value < 0.05 considered as significant. RESULTS: A total of 60 preterm neonates were randomized with 30 neonates in the melatonin (median [interquartile range] GA: 30.86 [3.78] weeks, BW: 1160 [430] grams) and 30 neonates in the 24% sucrose (median [IQR] GA: 29.29 [4.68] weeks, BW: 1070 [315] grams) group. The median PIPP score during the procedure in the melatonin and sucrose groups were 17 and 16, respectively (p=0.64). The median (Q1-Q3) PIPP score at the 1st minute was significantly lower among the melatonin group (7 [5.25-10]) vs 24% sucrose group (9.5 [7.25-11]) (p=0.02); and at the 5th minute, the median (Q1-Q3) PIPP scores in the melatonin group (5 [4-6]) was comparable to the 24% sucrose group (5.5 [3.25-7]) (p= 0.52). CONCLUSIONS: Oral melatonin is not inferior to oral 24% sucrose for pain management during ROP screening.

Manual Method vs Breast Pump for Breast Milk Expression in Mothers of Preterm Babies During First Postnatal Week: A Randomized Controlled Trial.

OBJECTIVES: To compare breast milk volume between manual method and breast pump expression in mothers of preterm infants at different time point of first week. DESIGN: Randomized controlled trial. SETTING: Postpartum ward of Obstetrics department and tertiary level neonatal intensive care unit (NICU) in a single institution in Orissa between October, 2020 and May, 2021. PARTICIPANTS: Mothers who delivered before 34 completed weeks of gestation. INTERVENTIONS: Manual breastmilk expression (ME) group using Marmet technique and breast pump milk expression (PE) group using pigeon manual breast pump, initiated milk expression within one hour of delivery. OUTCOME MEASURES: Expressed breast milk (EBM) volume in mothers of preterm infants at different time point of first week, and cumulative milk volume. RESULTS: Out of 170 mothers (83 PE and 87 ME group), 7-days milk volume data was available for 137 (71 ME and 66 PE) mothers. In per protocol analysis for 126 mothers (63 in each group), the median (IQR) EBM volume on day 2 and day 7 of ME and PE groups were similar [10 (5,20) vs 12 (5,28), P=0.10] and [280 (220-356) vs 280 (220-360), P=0.66]. The median (IQR) cumulative EBM volume over first 7 days in ME group was not significantly different from PE group [733 (593-995) vs 848.5 (571-1009)] P=0.55). A similar number of mothers in the PE and ME group [56 (88.9%) vs 58 (92%); P=0.14] provided exclusive breast milk for their neonates during the first week. Similar results were found on intention to treat analysis. CONCLUSION: EBM volume expressed was comparable between mothers expressing manually or with breast pump.

Comparison of Continuous Real Time Blood Glucose Measurement With Venous Laboratory Blood Glucose Level in Neonates During Perioperative Period.

OBJECTIVES: To compare the continuous real time blood glucose (CG) measurement with venous laboratory blood glucose (LG) level in neonates during perioperative period. METHODS: Glucose levels were measured simultaneously by CG, glucometer glucose (GG) and LG at 40 time points in ten neonates during perioperative period. Intraclass correlation coefficient (ICC) and Bland Altman analysis were used for comparison. RESULT: Correlation between CG and LG was excellent (ICC= 0.953; P<0.001), and average difference was 23.8 (95%CI 52.9 to -5.3) mg/dL, showed better reliability than at hyperglycemic state (ICC=0.653; P=0.006). The GG-LG showed excellent reliability with ICC = 0.985; P<0.001 and average difference of 15.4 (95% CI 30.7 to 0.1) mg/dL. CG at euglycemic state (ICC= 0.880; P<0.001). CONCLUSION: CG measurement is reliable for blood sugar estimation in neonates; but has lower reliability for hyperglycemia. The continuous trend of glucose measurement by CG is helpful for timely diagnosis of hyperglycemia during perioperative period in neonates.