Single Breath Counting for Diagnosis and Prediction of Severity of Acute Asthma Exacerbation in Children.

OBJECTIVES: To find correlation between single breath counting (SBC) and spirometry in acute exacerbation of asthma in children. METHODS: A cross-sectional observational study including all children aged 6-12 y age, who presented in outpatient department or emergency room with acute exacerbation of asthma, not fitting in exclusion criteria were enrolled. SBC and spirometry parameters were obtained before treatment and 1 h after initiating treatment (GINA 2017 Guidelines). RESULTS: Significant correlation was observed in SBC and FVC (r = 0.349), FEV1 (r = 0.439), FEF25-75 (r = 0.424), and PEF (r = 0.593). Cutoff value of SBC of 23 was found to be suggestive of severe/life-threatening asthma with sensitivity of 83.3% and specificity of 84.4%. No significant association was found between percent change in SBC and spirometry parameters in response to treatment. CONCLUSIONS: SBC can be used to predict PEF, FEV1, FVC, and FEF25-75 of a patient aged between 6 and 12 y during acute asthma exacerbation. The observed cutoff value of 23 of SBC score has a good sensitivity and specificity to identify life-threatening/severe exacerbation. SBC score significantly increases in response to therapy.

The role of a neonatal hypothermia alert device in promoting weight gain in LBW infants.

BACKGROUND: Neonatal hypothermia is a significant risk factor for preterm and low birth weight (LBW) newborns, especially in India. Kangaroo Mother Care (KMC) is one recommended method of thermal control. A wearable device, TempWatch, has been developed to monitor for and detect hypothermia and to promote KMC for preterm and LBW infants. PURPOSE: This randomized controlled trial was designed to evaluate TempWatch's impact on weight gain, amount of KMC received, and length of hospital stay for LBW infants as compared to standard care. METHODS: Otherwise healthy LBW infants (with birthweights 1500-2300 g) admitted to a KMC ward of a government hospital in New Delhi, India were randomly allocated to a TempWatch group or a control group and wore the device until their time of discharge. 50 infants were enrolled in each group. All participants received standard-of-care temperature monitoring, and those in the control group were monitored using the hand-touch method. Each group also received sixth-hourly temperature monitoring. Infants' daily weight and the number of hypothermia episodes they experienced per day were recorded, and mothers of infants in both groups completed daily KMC diaries. RESULTS: The TempWatch group experienced statistically significant weight gain as compared to the control group (0.06 vs. 0.02 kg, p = .024). There were no statistically significant differences between the groups in the number of hypothermia events detected, the amount of KMC received. CONCLUSION: TempWatch promotes statistically significant weight gain for LBW infants as compared to standard care.

Intrapartum cardiotocographic monitoring and its correlation with neonatal outcome.

Introduction: Despite the advancements in perinatal care in past decades, perinatal asphyxia remains a serious problem leading to significant perinatal morbidity and mortality. Therefore, foetal monitoring during the intrapartum period is of paramount importance. Among various methods of fetal monitoring, cardiotocography is a form of electronic foetal monitoring in which there is simultaneous recording of foetal heart rate and uterine contractions. Materials and Methods: This cross-sectional observational study was done in the labour room and neonatal intensive care unit (NICU) of a teaching Municipal Hospital in North India including 500 pregnant women of age group 18-45 years with singeleton fetus of gestation ≥36 weeks without any known congenital anomaly. Intrapartum cardiotocography (CTG) for 20 minutes was done within 12 hours prior to delivery and babies born to them were observed for birth asphyxia as Apgar score <7 at 1 minute as per using APGAR score less than 7 at 1 minute as per south east asia regional neonatal perinatal database (SEAR-NPD), world health organization (WHO) working definition. Results: CTG tracing was normal/reassuring in 92% of pregnant women, nonreassuring in 7% and was abnormal in only 1%. In patients with abnormal and nonreassuring CTG, delivery by lower segment cesarian section (LSCS) was significantly high (P < .0001). APGAR scoring was done at 1 minute and 5 minutes of life, it was found that 4% babies were having score less than 7 at 1 minute with incidence of birth asphyxia 40 per 1,000 live births Neonatal seizure was significantly more in nonreassuring and abnormal CTG group (P value <.0001). Conclusion: Abnormal CTG tracings result in higher incidence of operative interventions for deliveries. Abnormal CTG pattern during intrapartum CTG has high specificity and negative predictive value but has low sensitivity and positive predictive value for detection of birth asphyxia and need for NICU admission.

COVID-19 preparedness-a survey among neonatal care providers in low- and middle-income countries.

OBJECTIVE: To evaluate COVID-19 pandemic preparedness, available resources, and guidelines for neonatal care delivery among neonatal health care providers in low- and middle-income countries (LMICs) across all continents. STUDY DESIGN: Cross-sectional, web-based survey administered between May and June, 2020. RESULTS: Of 189 invited participants in 69 LMICs, we received 145 (77%) responses from 58 (84%) countries. The pandemic provides significant challenges to neonatal care, particularly in low-income countries. Respondents noted exacerbations of preexisting shortages in staffing, equipment, and isolation capabilities. In Sub-Saharan Africa, 9/35 (26%) respondents noted increased mortality in non-COVID-19-infected infants. Clinical practices on cord clamping, isolation, and breastfeeding varied widely, often not in line with World Health Organization guidelines. Most respondents noted family access restrictions, and limited shared decision-making. CONCLUSIONS: Many LMICs face an exacerbation of preexisting resource challenges for neonatal care during the pandemic. Variable approaches to care delivery and deviations from guidelines provide opportunities for international collaborative improvement.

Clinical Validation of Mobile Cardiotocograph Device for Intrapartum and Antepartum Monitoring Compared to Standard Cardiotocograph: An Inter-Rater Agreement Study.

Objective: Electronic fetal monitoring (EFM) using cardiotocograph (CTG) is commonly used both to assess fetal wellbeing in late antepartum and for intervention during intrapartum period. We validated the performance of indigenously developed mobile cardiotocograph (CTG) device with wireless probes compared to standard CTG device. Materials and methods: We sequentially used mobile and standard CTG devices in 495 pregnant women in labour and 359 pregnant women with gestation > 32 weeks. The CTG interpreted by two independent obstetricians in a blinded manner were compared to estimate the agreement by kappa (k) statistic. Results: High level of agreements between mobile and standard CTG devices for both intrapartum (87.9%; kappa 0.61) and antepartum monitoring (91.2%; kappa 0.60) were observed. Most of the pregnant women (80% in intrapartum and 70% in antepartum groups) and all nurses and obstetricians preferred the mobile CTG device over standard CTG device. Conclusion: The mobile CTG device can reliably be used for both intrapartum and antepartum monitoring instead of the standard CTG devices. The smaller size, portability and ability to transmit the recordings for second opinion make it suitable for use by midwives for appropriate triaging and referral. Wider availability of CTG and interpretation support at the peripheral facilities would assist identifying at-risk pregnancies and foetuses for timely referral and appropriate action to reduce perinatal deaths, stillbirths and birth asphyxi.

Improving quality of care during childbirth in primary health centres: a stepped-wedge cluster-randomised trial in India.

BACKGROUND: Low/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models. METHODS: We conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3 months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for 'months of intervention'. RESULTS: The intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities. CONCLUSION: A multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India. TRIAL REGISTRATION NUMBER: CTRI/2016/05/006963.