Efficacy of Skin-to-Skin Care versus Swaddling for Pain Control Associated with Vitamin K Administration in Full-Term Neonates: A Randomized Controlled Trial.

OBJECTIVE: The objective of the study was to assess the efficacy of immediate skin-to-skin care (SSC) versus swaddling in pain response to intramuscular injection of vitamin K at 30 min of birth in neonates. METHODS: Healthy full-term newborns were enrolled immediately after normal vaginal delivery and randomized in two groups, SSC and swaddling. Neonatal Infant Pain Scale (NIPS) was measured before, immediately after and at 2 min after the injection. RESULTS: Total 100 newborns were enrolled in the study (50 in each group). The mean (SD) birth weight of newborns in the SSC and swaddling group was 2668 (256) and 2730 (348) g, respectively. NIPS was comparable between the SSC and swaddling at before [1.78 (0.58) vs. 1.96 (0.83), p = 0.21], and immediately after the injection [4.82 (0.72) vs. 5.08 (0.75), p = 0.08]. NIPS at 2 min after the injection was significantly low in the SSC group compared to the swaddling group [1.38 (0.70) vs. 2.88 (1.00), p < 0.001]. At 2 min after injection, the NIPS score was significantly lower than baseline in the SSC group (p = 0.002), while it was significantly higher in the swaddling group (p < 0.001). A significantly higher proportion of newborns had a NIPS score of more than three at 2 min after injection in the swaddling group as compared to the SSC group (22% vs. 2%, p < 0.001). CONCLUSION: Immediate SSC was more efficacious as compared to swaddling as a pain control intervention while giving vitamin K injection. CLINICAL TRIAL REGISTRATION: The trial is registered with the Clinical Trial Registry of India with Registration number: CTRI/2020/01/022984.

Skin-to-skin care and swaddling are commonly used non-pharmacological measures to reduce pain perception in neonates for invasive procedures like heel prick, venipuncture and vaccination. We did this randomized control trial to compare the efficacy of immediate skin-to-skin care after birth vs. swaddling for reducing neonatal pain associated with intramuscular injection of vitamin K at 30 min after birth. We observed that the immediate skin-to-skin care, a standard of care, is more efficacious in controlling pain compared to swaddling for giving routine intramuscular vitamin K injection within one hour of birth.

Skin-to-Skin Care by Mother vs. Father for Preterm Neonatal Pain: A Randomized Control Trial (ENVIRON Trial).

OBJECTIVE: To compare skin-to-skin care (SSC) given by mother and father for preterm neonatal pain control by premature infant pain profile (PIPP) score. METHODS: 64 stable preterm (28-36 weeks gestational age) neonates born at a level-3 neonatal intensive care unit were included in the trial. Random allocation with the help of a computer-generated sequence was done. In group A, SSC was given by the mother 15 minutes before the first heel-stick, and subsequently, SSC was given by the father before the second heel-stick. In group B, the sequence of SSC provider was reversed. Blinded PIPP score assessment at 0, 1, and 5 minutes of heel-stick were done by two independent assessors using video recording. RESULTS: The mean (SD) birth weight was 1665.18 (339.35) grams, and mean (SD) gestational age was 34.28 (2.24) weeks. The PIPP score at 0, 1, and 5 minutes had no statistical or clinically significant differences between both groups (PIPP score mean (SD) at 0 minute = 3.20 (1.11) vs. 3.01 (1.29), p value = 0.38; 1 minute = 8.59 (4.27) vs. 8.26 (4.08), p value = 0.66; 5 minutes = 3.79 (1.40) vs. 3.93 (1.99), p value = 0.65 in SSC by mother and father group, respectively). Furthermore, there was no statistical difference between the groups for any components of the PIPP score (all p values > 0.05). The PIPP score at 5 minutes almost attained the 0-minute level in both the groups. CONCLUSION: Father is as effective as the mother for providing skin-to-skin care for preterm neonatal pain control. This trial is registered with CTRI/2018/01/016783.

Embrace versus Cloth Wrap in preventing neonatal hypothermia during transport: a randomized trial.

BACKGROUND: We assessed the efficacy of Embrace Nest Infant Warmer versus Cloth Wrap in preventing hypothermia during short-term transport from the emergency department (ED) to the neonatal intensive care unit (NICU). METHODS: Neonates weighing ≥1500 g coming to the ED were randomized for transport to the NICU. Axillary temperature was measured. RESULTS: A total of 120 newborns (60 per group) were enrolled. From ED exit to NICU entry, the mean (SD) temperature increased in the Embrace group by 0.37 °C (0.54), whereas it reduced by 0.38 °C (0.80) in the Cloth group (p < 0.001). Hypothermia cases reduced in the Embrace group from 39 (65%) to 21 (35%), while it increased from 21 (35%) to 39 (65%) in the Cloth group (p = 0.001) from ED exit to NICU entry. The thermoregulation for 24 h after admission to the NICU was superior in the Embrace group. CONCLUSIONS: Embrace showed significantly better thermoregulation in neonates. Further studies should be done to measure its effectiveness in different environments and distances.

Pain profile of premature infants during routine procedures in neonatal intensive care: An observational study.

BACKGROUND: Premature neonates receive a large number of painful procedures during their stay in the neonatal intensive care unit (NICU). However, there are many other processes that happen in the NICU, which may not be considered painful but can cause discomfort and/or stress to the neonate. METHOD: Pain profile during routine procedures in NICU was assessed using the premature infant pain profile (PIPP) score. Neonates of gestational age >26 weeks, less than 7 days old and admitted for less than 7 days in the NICU were included. RESULTS: A total of 662 procedures were observed in 132 (78 M, 54 F) neonates. The mean (SD) age of the neonates was 2.4 (1.8) days and the mean (SD) birth weight was 2.3 (0.6) kg. 63 (54.5%) were of low birth weight (LBW), 85 (64.39%) were full term. High PIPP score was noted in blood sampling, heel prick, suction, and weight measurement. Significant differences were observed in the PIPP score during blood sampling and suction across gender. Some ordinary and non-stressful procedures also scored very high on the PIPP scale. CONCLUSIONS: The validity of PIPP needs to be reexamined. Our understanding of pain during routine procedures may need to be revisited.

Blinded randomized crossover trial: Skin-to-skin care vs. sucrose for preterm neonatal pain.

OBJECTIVE: To compare skin-to-skin care (SSC) and oral sucrose for preterm neonatal pain control. METHODS: Preterm neonates (28-36 weeks gestation) requiring heel-stick were eligible. In group-A, SSC was given 15-min before first heel-stick, and sucrose was given 2-min before second heel-stick. In group-B, the sequence was reversed. Blinded premature infant pain profile (PIPP) score assessment was done at 0, 1, and 5-min of heel-stick by two assessors. RESULTS: A hundred neonates were enrolled. The inter-rater agreement for the PIPP score was good. The behavior state component was significantly lower in the sucrose group at all assessment points. The mean (SD) difference between 1-min and 0 min was similar [SSC 3.58(3.16) vs. sucrose 4.09(3.82), p = 0.24] between groups. The PIPP score attained baseline values at 5-min in both groups. CONCLUSION: Albeit sucrose indicated instantaneous action, SSC and sucrose have comparable clinical efficacy for preterm neonatal pain control. Multisensory stimulation with SSC may result in a higher behavioral state component of the PIPP score.

Prayers and beliefs among relatives of children admitted in pediatrics wards.

CONTEXT: Spirituality/Religion is important to many parents and they may call upon God to make the child healthier and normal. AIMS: We surveyed parents/relatives of children admitted to in-patient services for their praying practices and beliefs thereof. SETTINGS AND DESIGN: Cross-sectional survey in 150 parents/relatives of patients admitted to pediatric ward, pediatric intensive care (PICU) unit, and neonatal intensive care unit (NICU) (50 each). MATERIALS AND METHODS: We collected demographic, praying practices' information and asked them to fill a Prayer Questionnaire Score Chart which classified the individual's religiosity. STATISTICAL ANALYSIS USED: Descriptive statistics, Chi-square test, independent t-test, and one-way ANOVA were used for analysis. RESULTS: Hindus constituted 126 (84%) participants. In 118 (78.67%) cases, mothers responded to survey. Average time of prayer in PICU (159 min) was more than NICU (109 min) and pediatric ward (114 min). Average frequency of prayer before admission (10.49) was less significant than frequency of prayer after admission (13.64) (P value < 0.001). Most of the people, 91 (60.67%), prayed by standing near statues of God or praying silently while recalling God's images. Almost all people, 149 (99.33%), believed that both medical care and prayer were required for recovery of patient. According to patient's relatives, average 52% recovery of patient was due to medicine. CONCLUSIONS: Prayer was an integral component of parents/relatives' daily spiritual/religious ritual that was directed toward the admitted child's recovery. Statistically significant increase in frequency of praying after admission indicates the importance of prayers and spirituality in their minds as a part of treatment.

Premenstrual syndrome in Anand District, Gujarat: A cross-sectional survey.

AIM OF STUDY: We assessed the prevalence and severity of premenstrual syndrome (PMS) in adolescents and identified probable associations of PMS and premenstrual dysphoric disorder (PMDD) with age, locality, food habits, obesity, stress, genetic influence, menorrhagia and dysmenorrhoea. METHODS: Cross-sectional study in schools of Anand District in State of Gujarat, India. We conducted the study in 1702 girls in the age group of 8-23 years who had achieved menarche. MAIN OUTCOME MEASURES: Prevalence of PMS and PMDD using the self-administered Premenstrual Symptoms Screening Tool for Adolescents (PSST-A). RESULTS: The prevalence of moderate to severe PMS was 19.3% and PMDD was 4.6%. Almost all (94.8%) girls had at least one PMS symptom with 65.7% having moderate to severe symptoms. We found dysmenorrhoea in 71.2% girls and menorrhagia in 15.2%. Physical symptoms were reported by 53.5%, disruption of daily activities by 41.7%, while 25.1% had to miss school/college. Majority (81.3%) felt that PMS was a normal part of menstruation and 53.0% reported moderate to severe stress. Multivariate logistic regression model revealed older age, dysmenorrhoea, menorrhagia, high levels of stress and PMS in mother to be significantly associated with PMS. In addition to these, lower age at menarche and junk food significantly contributed to PMDD. CONCLUSION: Prevalence of moderate to severe PMS and PMDD in this population falls within the range reported elsewhere. PMS/PMDD affects the lives of many, significantly reducing their efficiency and worsening the quality of life.

Efficacy of Polyethylene Skin Wrapping in Preventing Hypothermia in Preterm Neonates (<34 Weeks): A Parallel Group Non-blinded Randomized Control Trial.

OBJECTIVE: The objective of this study was to determine the efficacy of polyethylene skin wrapping on thermoregulation in preterm neonates. METHODS: Total 151 neonates were enrolled in this randomized control trial. In the control group, neonates were transferred to the radiant warmer and covered with warm cloth after initial care. In the study group, neonates were transferred to the radiant warmer and placed in a food-grade polyethylene bag for 1 h. Axillary temperature of all neonates was recorded for first 24 h at frequent time intervals. RESULTS: Mean temperature reached to normal range earlier and remained significantly higher in the study group for most time intervals, and this difference persisted even at 24 h. Significantly less number of preterm newborns suffered from hypothermia in the study group as compared with the control group [50 (67.6%) vs. 67 (87%), p = 0.004]. CONCLUSIONS: Polyethylene wraps achieved rapid, sustained thermal control and were effective in preventing hypothermia in preterm newborns.

Sucrose vs. skin to skin care for preterm neonatal pain control-a randomized control trial.

OBJECTIVE: To compare the efficacy of SSC with oral Sucrose for pain management in preterm neonates. METHODOLOGY: Parallel-group, assessor-blinded randomized control trial conducted from February-June 2017 at a level 3B-NICU. Hundred preterm neonates (29-0/7 to 36-6/7 weeks gestational age) requiring heel-stick were randomly assigned (1:1), to SSC (50, Group-A) and Sucrose (50, Group-B). In Group-A, SSC was provided at least 10 min before the procedure. In Group-B, 0.2 ml of oral Sucrose was provided 2 min before the procedure. Blinded assessment of Premature Infant Pain Profile (PIPP) score was done 30 s post-procedure using recorded videos. RESULTS: Baseline variables were [Mean(SD)] gestational age [32.79(2.34) weeks], age [14.04(11.10) days] and birth weight [1.62(0.35) kilograms]. PIPP score was less in group- A vs. B but could not achieve statistical significance [Mean(SD): 7.74(2.43) vs. 8.1(2.82), p = 0.50 CI of the difference: (-1.40,0.68)]. CONCLUSIONS: SSC and Sucrose have comparable efficacy in managing pain in premature neonates.

Pain Control Interventions in Preterm Neonates: A Randomized Controlled Trial.

OBJECTIVE: To compare individual efficacy and additive effects of pain control interventions in preterm neonates. DESIGN: Randomized controlled trial. SETTING: Level-3 University affiliated neonatal intensive care unit. PARTICIPANTS: 200 neonates (26-36 wk gestational age) requiring heel-prick for bedside glucose assessment. Exclusion criteria were neurologic impairment and critical illness precluding study interventions. INTERVENTION: Neonates were randomly assigned to Kangaroo mother care with Music therapy, Music therapy, Kangaroo Mother care or Control (no additional intervention) groups. All groups received expressed breast milk with cup and spoon as a baseline pain control intervention. MAIN OUTCOME MEASURES: Assessment of pain using Premature Infant Pain Profile (PIPP) score on recorded videos. RESULTS: The mean (SD) birth weight and gestational age of the neonates was 1.9 (0.3) kg and 34 (2.3) wk, respectively. Analysis of variance showed significant difference in total PIPP score across groups (P<0.001). Post-hoc comparisons using Sheffe's test revealed that the mean (SD) total PIPP score was significantly lower in Kangaroo mother care group [7.7 (3.9) vs. 11.5 (3.4), 95% CI(-5.9, -1.7), P<0.001] as well as Kangaroo mother care with Music therapy group [8.5 (3.2) vs. 11.5 (3.4), 95%CI (-5.1, -0.9), P=0.001] as compared to Control group. PIPP score was not significantly different between Control group and Music therapy group. CONCLUSIONS: Kangaroo mother care with and without Music therapy (with expressed breast milk) significantly reduces pain on heel-prick as compared to expressed breast milk alone. Kangaroo mother care with expressed breast milk should be the first choice as a method for pain control in preterm neonates.

Clinical Profile and Outcome of Newborns with Acute Kidney Injury in a Level 3 Neonatal Unit in Western India.

INTRODUCTION: Acute Kidney Injury (AKI) is a serious condition in neonatal care. It complicates the management necessitating the restrictive use of medications. AIM: To evaluate clinical profile, identify associated and prog-nostic factors in newborns with AKI. MATERIALS AND METHODS: This was a case control study done between January 2008 to January 2010. Total 1745 newborns were admitted, of which 74 babies had AKI. It was defined as serum creatinine >1.5mg/dl. Control group was selected randomly from the hospital numbers of the newborns derived from the electronic registry with serum creatinine below 1.5 mg/dl. Demographic variables like birth weight, gender, gestational age, admission age, growth restriction, Apgar scores, electrolyte levels; and common clinical conditions like asphyxia, sepsis, meningitis, persistent pulmonary hypertension, Necrotizing Enterocolitis (NEC), mechanical ventilation, congenital heart disease; were compared amongst the two groups. Information was obtained from the admission register, admission files, labor register of obstetrics and gynaecology department and electronic registry. Chi square/independent sample t-test as applicable and logistic regression were used to establish an association of various factors and outcome with AKI. RESULTS: The incidence of AKI in our study was 4.24%. Demographic variables more common in AKI group were inborn (p=0.011), male gender (p=0.032), term gestation (p=0.001), Appropriate for gestational age (0.001), higher birth weight (p<0.001), full term (p<0.001), sepsis (p<0.001), NEC (p=0.042), low ApGAR scores at one minute (p=0.011) and five minute (p=0.003). However, on multivariate logistic regression only male gender [Odds Radio (OR)=2.84, Confidence Interval (CI)=1.12-7.21] and Sepsis (OR=14.46, CI=4.5-46.46) were associated with AKI. Respiratory distress syndrome was more prevalent in the control group (p<0.003). No need of mechanical ventilation and absence of shock, improved the survival. CONCLUSIONS: AKI continues to be of clinical significance in neonatal intensive care. Further studies are needed to evaluate newer associations (like male gender and low APGAR scores).

RAHI-SATHI Indo-U.S. Collaboration: The Evolution of a Trainee-Led Twinning Model in Global Health Into a Multidisciplinary Collaborative Program.

BACKGROUND: In recent years there has been a surge in the number of global health programs operated by academic institutions. However, most of the existing programs describe partnerships that are primarily faculty-driven and supported by extramural funding. PROGRAM DESCRIPTION: Research and Advocacy for Health in India (RAHI, or "pathfinder" in Hindi) and Support and Action Towards Health-Equity in India (SATHI, or "partnership" in Hindi) are 2 interconnected, collaborative efforts between the University of Massachusetts Medical School (UMMS) and Charutar Arogya Mandal (CAM), a medical college and a tertiary care center in rural western India. The RAHI-SATHI program is the culmination of a series of student/trainee-led research and capacity strengthening initiatives that received institutional support in the form of faculty mentorship and seed funding. RAHI-SATHI's trainee-led twinning approach overcomes traditional barriers faced by global health programs. Trainees help mitigate geographical barriers by acting as a bridge between members from different institutions, garner cultural insight through their ability to immerse themselves in a community, and overcome expertise limitations through pre-planned structured mentorship from faculty of both institutions. Trainees play a central role in cultivating trust among the team members and, in the process, they acquire personal leadership skills that may benefit them in their future careers. CONCLUSION: This paradigm of trainee-led twinning partnership promotes sustainability in an uncertain funding climate and provides a roadmap for conducting foundational work that is essential for the development of a broad, university-wide global health program.

Umbilical Venous Catheter Versus Peripherally Inserted Central Catheter in Neonates: A Randomized Controlled Trial.

Peripherally inserted central catheter (PICC) and umbilical venous catheter (UVC) in terms of success rate, complications, cost and time of insertion in neonatal intensive care were compared. Neonates requiring vascular access for minimum 7 days were included. Sample size of 72 per group was determined. Trial was registered at Clinical Trials Registry of India (CTRI/2015/02/005529). Success rates of the UVC and PICC were 68.1% and 65.3%, respectively (p = 0.724). Mean (SD) time needed for PICC and UVC insertion was 34.13 (34.69) and 28.31 (17.19) min, respectively (p = 0.205). Mean (SD) cost of PICC insertion vs. UVC insertion was 60.9 (8.6) vs. 11.9 (8.7) US dollars (p < 0.0001). Commonest cause for failure of UVC was displacement [6 (8.3%)] and that for PICC was blockage [9 (12.5%)]. CONCLUSIONS: UVC is a cheaper alternative to PICC, with similar success rate, short-term complications and time needed for insertion.

An Educational Intervention to Improve Nurses' Understanding of Pain in Children in Western India.

Accurate assessment of pain and its management is a challenging aspect of pediatric care. Nurses, usually the primary caregivers, showed inadequate knowledge and restrictive attitudes toward pain assessment. We evaluated an educational intervention to improve nurses' assessment of pain in a teaching hospital in India. A convenient sample of nurses working in the neonatal intensive care unit, pediatric ward, pediatric intensive care unit, and pediatric cardiac intensive care unit were included in the study. Workshops to improve understanding of pain, its assessment, and management strategies were conducted. A modified and consensually validated Knowledge and Attitudes Survey Regarding Pain questionnaire-2008 consisting of 25 true/false questions, eight multiple choice questions, and two case scenarios was administered before, immediately after, and 3 months after the workshops to evaluate impact of the intervention. Eighty-seven nurses participated. Mean (standard deviation) experience was 4.04 (5.9) years. Thirty-seven percent felt that they could assess pain without pain scales. About half (49.4%) of the nurses had not previously heard of pain scales, while 47.1% reported using a pain scale in their routine practice. Significant improvement was observed between pretest and post-test total scores (15.69 [2.94] vs. 17.51 [3.47], p < .001) as well as the pretest and retention score (15.69 [2.94] vs. 19.40 [4.6], p < .001). Albeit the study site and sampling frame may limit the reliability of the findings, the educational intervention was successful, and better retention test scores suggest a cascading effect. Pain assessment and management education of children should be incorporated in the nursing curriculum and should be reinforced in all pediatric units.

Educational intervention to improve intravenous cannulation skills in paediatric nurses using low-fidelity simulation: Indian experience.

INTRODUCTION: Inserting, monitoring and maintaining intravenous access are essential components of nursing. We evaluated simulation training on a manikin to improve cannulation skills. METHODS: Nursing staff managing paediatric patients were asked to cannulate NITA Newborn-1800 manikin before and after appropriate training. Skills were assessed by a single assessor using an objective structured clinical examination (OSCE) checklist. Four steps were identified as critical. A score of 8/10 (80%) was considered satisfactory. Knowledge was assessed by 10 questions. A training module consisting of theoretical aspects, PowerPoint presentations, videos and hands on training over a manikin was conducted. Post-training assessment was done 1 week later. RESULTS: Seventy-five (80.6%) nurses who completed preassessments and postassessments were assessed for paired comparisons of knowledge and skill. The majority of the nurses were females, had contractual appointment, were in their early career phase and from the paediatric wards. The mean (SD) post-training knowledge score was greater vis-a-vis pretraining score (7.52 (1.58) vs 5.32 (1.57), P<0.001). A similar result was observed for total OSCE scores (9.22 (0.66) vs 7.91 (1.11), P<0.001). Significantly higher proportion of participants exhibited intravenous cannulation satisfactorily after the training vis-a-vis pretraining assessment (69 (92%) vs 36 (48%), P<0.001). CONCLUSION: Training using manikin showed improvement in post-training score of intravenous cannulation skill of paediatric nurses; however, this finding needs further confirmation by a randomised control trial, as our study does not have a control group.

Missed Opportunities for Sedation and Pain Management at a Level III Neonatal Intensive Care Unit, India.

BACKGROUND: Neonates in the neonatal intensive care unit (NICU) undergo a multitude of painful and stressful procedures during the first days of life. Stress from this pain can lead to neurodevelopmental problems that manifest in later childhood and should be prevented. OBJECTIVE: To determine the number of painful procedures performed per day for each neonate, to verify documentation of painful procedures performed, and to, subsequently, note missed opportunities for providing pain relief to neonates. METHODS: We conducted a cross-sectional study at a level III NICU located in a rural part of western India. A total of 69 neonates admitted for more than 24 h were included. Twenty-nine neonates were directly observed for a total of 24 h each, and another 40 neonatal records were retrospectively reviewed for the neonate's first 7 days of admission. All stressful and painful procedures performed on the neonate were recorded. Also recorded were any pharmaceutical pain relief agents or central nervous system depressants administered to the neonate before or at the time of the procedures. Average nurse-patient ratio was also calculated. Data were analyzed using descriptive statistics. RESULTS: A documentation deficit of 2.2% was observed. The average nurse-patient ratio was 1.53:1. A total of 13711 procedures were recorded, yielding 44.1 (38.1 stressful, 3.8 mildly painful, and 2.2 moderately painful) procedures per patient day. Common stressful procedures were position changing (2501) and temperature recording (2208). Common mildly and moderately painful procedures were heel prick (757) and endotracheal suctioning (526), respectively. Use of pharmacological agents coincided with 33.48% of the procedures. The choice of drug and time of administration were inappropriate, indicating that the pharmacological agents were intended not for pain relief but rather for a coexisting pathology or as sedation from ventilation with no analgesia. CONCLUSION: Stressful procedures are common in the NICU; mildly and moderately painful procedures fairly common. Almost two-thirds of the times, no pharmaceutical pain relief methods were used, and when administered, the pharmaceutical agents were seldom intended for pain relief; this implies poor pain management practices and emphasizes the imperative need for educating NICU nurses, residents, fellows, and attendings.

Infant and Young Child Feeding Practices in Infants Receiving Skin to Skin Care at Birth: Follow-up of Randomized Cohort.

INTRODUCTION: Skin to Skin Care (SSC) in neonatal period influences immediate breastfeeding outcomes in early childhood, especially the duration of exclusive breastfeeding. AIM: We investigated influence of 17 hours of SSC given from day one of life on Infant and Young Child Feeding (IYCF) practices through one year of life. MATERIALS AND METHODS: Follow-up of a Superiority Randomized Control Trial (RCT) (CTRI/2013/06/003790) conducted in a teaching hospital located in central Gujarat. Mothers of 100 neonates (48 girls, 52 boys) from previous study cohort of RCT on SSC were followed. A survey on IYCF practices during the first year of life was administered after the end of infancy. In RCT, 50 neonates had received SSC beginning of 30 min- 1 hour after birth for average 17 hours on day 1 of life. In the control group, 50 newborn were placed next to the mother and conventional care was provided. There was a significant difference between hypothermia incidences in these groups in the first two days of life. RESULTS: There was no difference in the groups as far as the duration of exclusive breastfeeding, number of times breastfed per day, or stoppage of night feeds. No baby in either group received bottled feeds but about 53 received some form of extra lacteal feeds in the first 6 months without significant group difference. Fewer SSC mothers reported difficulties with breastfeeding or extra lacteal supplementation. All mothers who faced problems contacted physicians for advice and 20 were advised top milk and 6 given other foods. At one year of life 66% mothers were giving less than the recommended five food servings. There was no difference in practices related to hand washing, food preparation and storage, feeding habits of child and illness episodes in the children. CONCLUSION: IYCF practices in this small group were not as per guidelines. Few positive trends were seen with fewer SSC mothers facing problems related to breastfeeding. The study was underpowered to detect differences in IYCF practices in relation to SSC.

Randomized control trial of high fidelity vs low fidelity simulation for training undergraduate students in neonatal resuscitation.

BACKGROUND: Knowledge acquisition and skill maintenance are important in learning neonatal resuscitation. Traditionally this is taught by using low fidelity mannequins. Technological advancement enabled a move towards high fidelity mannequins. In a low resources setting, it is incumbent to ensure reasonable cost benefit ratio before investing in technology. METHODS: A randomized control trial was conducted in 101 undergraduate students who were assigned to conventional Resusci(®) Baby Basic or SimNewB group over a period of 3 days. The lectures were the same for both groups but the hands on training was on different mannequins. There were five experienced and accredited teachers who were standardized for training the students. Both the groups received a written test and a Megacode before and after the training, and 3 months later a post-test. RESULTS: The baseline written exam score (p = 0.07), Megacode assessment score (p = 0.19) and sex distribution (p = 0.17) were similar in both groups. Both groups showed significant improvement in the written exam score as well as in the Megacode assessment score at post-test and 3 months (retention) period. However there was no significant difference in the "improvement" between both the groups with respect to written exam (p = 0.38) or Megacode assessment (p = 0.92). Further the post-test and 3 month scores were comparable for the skills as well as content components suggesting that the skills were retained in 3 months with an opportunity of self learning them. CONCLUSIONS: Due diligence is a caveat before contemplating the acquisition of high fidelity mannequins by educational centers for neonatal resuscitation.

Breastfeeding Practices, Demographic Variables, and Their Association with Morbidities in Children.

Appropriate feeding practices are the key contributor to reducing morbidities and mortalities in under-five children. A cross-sectional questionnaire based survey of mothers of children aged less than 5years was conducted in 781 mothers. More than half of mothers (57.5%) started feeding within an hour of birth, 55.9% gave exclusive breastfeeding for six months, 89.1% of the mothers stopped breastfeeding before two years of age, 18.2% of the mothers bottle-fed the babies, and 15.6% had problems during breastfeeding in first 6 months. Early initiation of breastfeeding within one hour of birth promoted exclusive breastfeeding, and breastfeeding for longer duration. Exclusive breastfeeding increased frequency of feeds. Multivariable logistic regression showed that initiation of breastfeeding after an hour of birth (p = 0.035), not providing exclusive breastfeeding for 6 months (p < 0.0001), unemployed mothers (p = 0.035), having two or more kids (p = 0.001), and complementary feeds given by person other than mother (p = 0.007) increased hospitalization. Starting breastfeeding after an hour of birth (p = 0.045), severe malnutrition (p = 0.018), and breastfeeding for < two years (p = 0.026) increased rates of diarrhea. Breastfeeding practices were not optimum and interventions to improve these practices need to be strengthened.