Hypoglycaemia in high-risk neonates on exclusive breastfeeding.

Background: Neonates at risk of hypoglycemia are often roomed in with mothers, but there is paucity of literature on the occurrence of hypoglycemia in these exclusively breastfed high-risk neonates. The primary objective was to estimate the incidence of hypoglycaemia in high-risk neonates on exclusive breastfeeding. The secondary objectives were to study the time of presentation, symptoms of hypoglycaemia, and the various maternal and neonatal risk factors. Methods: This prospective observational study was carried out in a tertiary care teaching hospital of eastern India between January 2017 and June 2018. All neonates roomed in with mothers with high-risk factors such as low birth weight, preterm, small for gestational age, large for gestational age and infants of diabetic mothers were included. All included neonates were exclusive breastfed and underwent blood glucose monitoring at 2, 6, 12, 24, 48 and 72 h of life using glucometer strips and also whenever clinical features suggested hypoglycaemia. Hypoglycemia was defined as the blood glucose level ≤46 mg/dL. Results: Of a total of 250 neonates studied, 52 (20.8%) developed hypoglycaemia in first 72 h. Hypoglycaemia was detected in most at 2 h with the second peak at 48 h of age. Only 8 (3.2%) neonates had symptomatic hypoglycaemia with jitteriness being the commonest symptom, followed by lethargy and poor feeding. Conclusion: There is a need to closely monitor the blood glucose levels for at least first 48 h in high-risk neonates roomed in with mothers on exclusive breastfeeding.

"Shunt Pumping Test": role of practice on an experimental model.

PURPOSE: To ascertain the benefits of practicing shunt pumping test on a validated experimental model. METHODS: A validated experimental model of shunt was used and 25 medical professionals were asked to assess the block in the model where artificial blocks were created. The assessment was repeated after the participants had practiced on the same model. The performance of participants before and after practice was compared and statistically evaluated. RESULTS: The ability to predict the status of shunt showed an improvement in all scenarios after practice. The odds ratio for predicting a blocked shunt before and after practice was 7.25 (95% credible interval: 1.50-21.01). The odds ratio for predicting a functional shunt before and after practice was 8.81 (95% credible interval of 1.64 to 13.65). CONCLUSION: Practicing on the experimental model significantly improves the ability to predict the status of shunt. Training of primary caregivers on similar shunt models based on the shunts used in respective centers can improve an early detection of shunt block and reduce reliance on more invasive and expensive evaluation modalities.

"Shunt pumping test": detecting its efficacy through an experimental model.

PURPOSE: Shunt pumping test has often been used clinically to detect functional status of ventriculoperitoneal (VP) shunt. Its ability to correctly predict the status is not reliably known. Ethical dilemmas make it difficult to perform any studies in patients with blocked shunts, and hence, a requirement of devising an experimental model was felt. METHOD: An experimental model was devised using a Chhabra Slit N Spring shunt. The pressures were maintained in the proximal and distal chamber by real-time monitoring and maintained similar to intra-ventricular and intra-abdominal pressures. Three such models with scenarios of proximal block (PB), distal block (DB), and a functional shunt (BO) were created. Twenty-five participants were tested using these models to assess the efficacy of shunt pumping test. RESULTS: The experimental model could be used successfully to perform the test. The sensitivity of the test to detect a shunt with block on any side (AB) was found to be 0.79 (95% confidence interval 0.72-0.85) and specificity to be 0.69 (95% confidence interval 0.59-0.80). Its ability to detect the side of block was also evaluated. Absolute correctness value, odds ratio, and interpersonal heterogeneity were also evaluated. Pressure changes in proximal and distal catheter on compressing the chamber in various scenarios were recorded. CONCLUSION: The shunt pumping test has moderate ability to predict a blocked shunt and can aid clinical assessment of shunt block. It has only limited ability to detect the side of block. Pressure changes in the proximal and distal catheters on chamber compression are commensurate with the rationale of "shunt pumping test."

Persistent pulmonary hypertension of the newborn: a review.

Persistent pulmonary hypertension of the newborn (PPHN) is a serious medical emergency in the neonatal period which occurs because of failure of transition of the foetal circulation into the normal circulation. The condition is characterised by persistently elevated pulmonary vascular pressures and despite numerous modalities of treatment available, the condition carries with it a high rate of mortality and morbidity. Early awareness of predisposing conditions and early diagnosis leads to better outcomes in PPHN.