Duration of Caffeine for Apnea of Prematurity-A Randomized Controlled Trial.

OBJECTIVES: There is sufficient evidence to support use of caffeine therapy for apnea of prematurity, but practices vary widely when it comes to discontinuing therapy. This study was planned to compare 'recurrence of apnea of prematurity' (RAP); when 2 protocols were used to stop caffeine therapy. METHODS: Neonates delivered at 26-32 wk gestation on caffeine therapy for apnea of prematurity were randomized into 2 groups: Group 1-caffeine stopped at 7 d apnea-free period, and Group 2-continued for a prefixed period till at least 34 wk postmenstrual age (PMA). Proportion of infants in each group with RAP were analyzed. RESULTS: Each group consisted of 60 infants. Proportion of infants in each group with RAP, were not different (15% vs 13%); odds ratio (OR) 0.87; 95% confidence interval (CI) (0.31-2.43). Caffeine could be stopped earlier (33 vs 34 wk PMA); and cumulative duration of therapy was lesser (19.5 vs 33 d) when stopped at 7 d apnea-free period. Other studied outcomes were similar between the two groups. CONCLUSIONS: Mandatorily continuing caffeine therapy up to 34 wk PMA in select preterm groups does not seem to decrease risk of recurrence of apnea. Larger trials that specifically study extremely preterm infants are required to make robust recommendations on when to stop therapy. CLINICAL TRIALS REGISTRY OF INDIA NO: CTRI/2016/12/007559. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=14195&EncHid=&modid=&compid=%27,%2714195det%27.

Exclusive Breast Milk vs. Hybrid Milk Feeding for Preterm Babies-A Randomized Controlled Trial Comparing Time to Full Feeds.

When breastmilk is insufficient to meet planned feed volumes, neonatologists need to continue parenteral nutrition (PN) or use formula. This trial conducted at a tertiary care unit in South India between August 2014 and April 2016 compared time to full feeds in preterms fed 'mother's milk alone(MM)' vs. 'hybrid feed-mother's milk supplemented with formula(HF)'. We also compared time to regain birth weights, duration of PN, feed intolerance, Necrotizing Enterocolitis stage 2 or more, all-cause mortality, Extrauterine growth restriction, Healthcare associated infections, exclusive breast milk feeding rates at discharge, Retinopathy of prematurity requiring laser therapy, abnormal neurosonogram and oxygen dependency at 28 days. Neonates between 27 and 32 weeks were randomized into MM/HF when breast milk was insufficient. HF received formula to reach targeted feed volumes. MM received more PN to meet fluid requirements. 54 babies were analyzed in MM and 58 in HF. Time to full feeds were similar-MM (14.1 ± 4 days); HF (13.5 ± 4 days), p = 0.45. Exclusive breast milk feeding rates at discharge were higher in MM when compared to HF (74% vs. 51%). Other secondary outcomes were similar between groups. When mother's milk is unavailable in sufficient quantities, preterm babies may receive hybrid feeds. (Clinical trials registry of India no. REF/2016/02/006622).

Neonatal seizures: Predictors of adverse outcome.

CONTEXT: Early detection of predictors of adverse outcome will be helpful for neonatologists to plan management, follow up and rehabilitation in advance so that neurological disability can be minimised. AIMS: The purpose of this study was to determine the factors affecting the adverse outcome of neonatal seizures. SETTINGS AND DESIGN: This is a prospective study conducted in the neonatal unit of a tertiary care hospital. One hundred and eight newborns consecutively admitted with seizures were included in this study. MATERIALS AND METHODS: Data was collected regarding perinatal history and seizure and evaluated for etiology. We conducted a retrospective analysis to identify the factors associated with adverse outcome after neonatal seizures. STATISTICAL ANALYSIS USED: Chi-square test with degree of freedom = 1 was used to find the variables significantly associated with adverse outcome (P < 0.05). RESULTS: Gestational age, birth weight, Apgar score at 5 min, seizure onset <24 hrs, status epilepticus, radiological findings and EEG findings were significantly associated with outcome. CONCLUSION: Mortality and severe neurological impairment after neonatal seizure is associated with prematurity, LBW, low Apgar score at 5 min, etiologies like meningitis, sepsis, severe HIE, brain malformations, grade 3 or 4 IVH or intracranial haemorrhage, seizure onset <24 hours, presence of status epilepticus, severely abnormal radiological and EEG findings.

The newborn with seizures -- a follow-up study.

OBJECTIVE: To determine the sequelae of neonatal seizures in a cohort of newborns, recruited over a six month period. DESIGN: Prospective hospital based study. SETTING: The neonatal intensive care unit (NICU) of a tertiary care hospital. PARTICIPANTS: 135 babies were recruited of whom 10 died and 25 were lost to follow up. METHODS: The cases were followed up over four months. RESULTS: 68% of the babies followed up were normal; 32% had an abnormal neurological outcome. Seven (7%) developed post-neonatal epilepsy. Hypocalcemia was significantly associated with mortality (OR: 21.9; 95% CI: 1.2-391.2). No risk factors could be identified for post neonatal epilepsy. Presence of spike waves in the EEG was significantly related to abnormal neurological outcome (OR: 3.5; 95% C.I. 1.2-10.8). CONCLUSIONS: Majority of neonates with seizures have a normal outcome with no developmental delay or neurological deficit. Predominantly spike waves in the EEG is predictive of abnormal neurological outcome.

Callosal agenesis and Open lip Schizencephaly.

We report a case of a new born who presented with neonatal seizures; and who had coexistence of a Corpus Callosum Agenesis with a bilateral Open lip Schizencephaly and a Dandy Walker malformation. The investigations for an underlying etiology, however was futile.

Persistent pulmonary hypertension of the newborn.

This article attempts to define a complicated, yet not rare disease of the neonate, which presents with extreme hypoxemia due to increased pulmonary vascular resistance, resulting in diversion of the pulmonary venous blood through persistent fetal channels, namely ductus arteriosus and foramen ovale. Pathophysiology, diagnostic approach and the various modalities of management are analyzed. Persistent pulmonary hypertension of the newborn is multi-factorial, which is reflected in the management as well. These babies are extremely labile to hypoxia and should be stabilized with minimum handling. One hundred percent oxygen and ventilation are the mainstay of treatment. The role of hyperventilation, alkalinization, various non-specific vasodilators such as tolazoline, magnesium sulphate, selective vasodilators such as inhaled nitric oxide, adenosine and the role of high frequency oscillatory ventilation and extra corporeal membrane oxygenation are discussed. With the newer modalities of management, the outlook has improved with mortality of less than 20% and fewer long-term deficits.

Sextuplets in Oman.

Use of ovulation inducing agents has increased the incidence of high order multifetal gestation. Such pregnancies are associated with increased maternal morbidity and poor perinatal outcome especially due to prematurity. Here, we report a case of sextuplet pregnancy following ovulation induction with gonadotrophins. This is the first reported case of sextuplets from Oman.

Retinopathy of prematurity in VLBW and extreme LBW babies.

OBJECTIVE: This is a hospital-based, prospective clinical study to determine the incidence, risk factors, and outcome of extreme low birth weight and very low birth weight pre-term babies with retinopathy of prematurity (ROP) at the Sultan Qaboos University Hospital, Oman. METHODS: All babies with a birth weight =/< 1500 g and gestational age =/< 32 weeks admitted in the Neonatal Unit, were screened for ROP between 4 to 6 weeks of age and staged according to the international classification and were followed up until complete vascularization of the retina. Fifty nine babies formed the study group. RESULTS: The overall incidence of ROP was 25.4% (15 out of 59), of which 6 babies had severe ROP and underwent cryotherapy/laser. All babies with ROP had a birth weight < 1250 g and were born before 31 weeks of gestation. CONCLUSION: ROP is a multifactorial disease, the immature retina of the pre-term baby being the primary factor. Incidence and severity was inversely proportional to birth weight and gestational age. Multiple logistic regression analysis showed that sepsis and total parenteral nutrition to be highly significant risk factors. Repeated blood transfusions, hypotension and congenital heart disease with left to right shunt were seen to be considerably associated with the development of ROP. A decrease in overall incidence and severity of ROP was observed in this study.